U.S. patent number 8,637,031 [Application Number 13/648,477] was granted by the patent office on 2014-01-28 for method of treating osteoarthritis with an antibody to ngf.
This patent grant is currently assigned to Regeneron Pharmaceuticals, Inc.. The grantee listed for this patent is Regeneron Pharmaceuticals, Inc.. Invention is credited to Lynn MacDonald, Joel H. Martin, Marc R. Morra, Joel C. Reinhardt, Paul Tiseo, Richard Torres.
United States Patent |
8,637,031 |
MacDonald , et al. |
January 28, 2014 |
Method of treating osteoarthritis with an antibody to NGF
Abstract
Methods are disclosed for treating osteoarthritis in a human
subject in need thereof, comprising administering to the subject a
therapeutically effective amount of an anti-human NGF antibody, or
antigen-binding fragment thereof, wherein at least one symptom
associated with osteoarthritis is prevented, ameliorated or
improved.
Inventors: |
MacDonald; Lynn (White Plains,
NY), Torres; Richard (New York, NY), Morra; Marc R.
(Beacon Falls, CT), Martin; Joel H. (Putnam Valley, NY),
Reinhardt; Joel C. (Mount Kisco, NY), Tiseo; Paul
(Greenwich, CT) |
Applicant: |
Name |
City |
State |
Country |
Type |
Regeneron Pharmaceuticals, Inc. |
Tarrytown |
NY |
US |
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Assignee: |
Regeneron Pharmaceuticals, Inc.
(Tarrytown, NY)
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Family
ID: |
43465465 |
Appl.
No.: |
13/648,477 |
Filed: |
October 10, 2012 |
Prior Publication Data
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Document
Identifier |
Publication Date |
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US 20130028892 A1 |
Jan 31, 2013 |
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Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
Issue Date |
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12888751 |
Nov 13, 2012 |
8309088 |
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12188330 |
Aug 2, 2011 |
7988967 |
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61246261 |
Sep 28, 2009 |
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60964224 |
Aug 10, 2007 |
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60994526 |
Sep 20, 2007 |
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61062860 |
Jan 28, 2008 |
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61079259 |
Jul 9, 2008 |
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Current U.S.
Class: |
424/145.1;
514/12.2; 514/10.8; 514/18.4; 514/18.3; 514/16.8 |
Current CPC
Class: |
A61K
9/0019 (20130101); A61P 25/04 (20180101); A61K
39/3955 (20130101); A61K 45/06 (20130101); A61P
25/08 (20180101); A61P 19/02 (20180101); C07K
16/22 (20130101); A61P 29/00 (20180101); A61K
2039/545 (20130101); C07K 2317/51 (20130101); C07K
2317/56 (20130101); C07K 2317/565 (20130101); C07K
2317/515 (20130101); C07K 2317/76 (20130101); A61K
2039/505 (20130101) |
Current International
Class: |
A61K
39/395 (20060101); A61K 38/35 (20060101); A61P
25/08 (20060101); A61P 29/00 (20060101); A61K
38/33 (20060101); A61P 25/04 (20060101) |
References Cited
[Referenced By]
U.S. Patent Documents
Foreign Patent Documents
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02/096458 |
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Dec 2002 |
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WO |
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2004/016769 |
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Feb 2004 |
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WO |
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2004/058184 |
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Jul 2004 |
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WO |
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2005/019266 |
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Mar 2005 |
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WO |
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2005/056601 |
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Jun 2005 |
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WO |
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2007/024846 |
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May 2007 |
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WO |
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2006/110883 |
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Oct 2010 |
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WO |
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2006/131951 |
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Dec 2010 |
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WO |
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2006/131952 |
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Dec 2010 |
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WO |
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Other References
Rudikoff et al. (1982) Proc Natl Acad Sci USA, 79(6):1979-1983.
cited by examiner .
Casset, F. et al., "A peptide mimetic of an anti-CD4 monoclonal
antibody by rational design" Biochem Biophys Res Commun. (2003)
307(1):198-205. cited by applicant .
Chen et al., "Selection and analysis of an optimized anti-VEFG
antibody: crystal structure of an affinity-matured Fab in complex
with antigen" J. Mol. Biol. (1999) 293(4):865-881. cited by
applicant .
Holm, P. et al., "Functional mapping and single chain construction
of the anti-cytokeratin 8 monoclonal antibody TS1" Mol. Immunol.
(2007) 44(6):1075-1084. cited by applicant .
MacCallum et al., "Antibody-antigen interactions: contact analysis
and binding site topography" J. Mol. Biol. (1996) 262:732-745.
cited by applicant .
Padlan et al., "Structure of an antibody-antigen complex: crystal
structure of the HyHEL-10 Fab-lysozyme complex" Proc. Natl. Acad.
Sci. USA (1989) 86:5938-5942. cited by applicant .
Safieh-Garabedian, B., et al., "Contribution of interleukin-1 beta
to the inflammation-induced increase in nerve growth factor levels
and inflammatory hyperalgesia" Brit. J. Pharmacol. (1995)
115:1265-1275. cited by applicant .
Vajdos, FF et al., "Comprehensive functional maps of the
antigen-binding site of an anti-ErbB2 antibody obtained with
shotgun scanning mutagenesis" J. Mol. Biol, (2002) 320(2):415-428.
cited by applicant .
We, P. Fundamental Immunology, Third Edition, Raven Press, New York
(1993) pp. 292-295. cited by applicant .
Wilson-Gerwing et al., "Neurotrophin-3 suppresses thermal
hyperalgesia associated with neuropathic pain and attenuates
transient receptor potential vanilloid receptor-1 expression in
adult sensory neurons" J. Neuroscience (2005) 25(3):758-767. cited
by applicant.
|
Primary Examiner: Ballard; Kimberly A
Attorney, Agent or Firm: Mallon; Veronica Gregg; Valeta
Bozicevic; Karl
Parent Case Text
CROSS-REFERENCE TO RELATED APPLICATIONS
This application is a continuation of U.S. patent application Ser.
No. 12/888,751, filed on Sep. 23, 2010 and issued on Nov. 13, 2012
as U.S. Pat. No. 8,309,088, which is a continuation-in-part of U.S.
patent application Ser. No. 12/188,330, filed on Aug. 8, 2008 and
issued on Aug. 2, 2011 as U.S. Pat. No. 7,988,967, which claims the
benefit under 35 USC .sctn.119(e) of U.S. provisional application
Nos. 60/964,224 filed Aug. 10, 2007; 60/994,526 filed Sep. 20,
2007; 61/062,860 filed Jan. 28, 2008; and 61/079,259 filed Jul. 9,
2008. This application also claims the benefit under 35 USC
.sctn.119(e) of U.S. provisional application No. 61/246,261 filed
Sep. 28, 2009. The disclosures of all of the foregoing are herein
incorporated by reference in their entireties.
Claims
What is claimed is:
1. A method for treating osteoarthritis in a human subject in need
thereof, comprising administering to the subject a therapeutically
effective amount of an anti-human NGF antibody, or antigen-binding
fragment thereof, wherein at least one symptom associated with
osteoarthritis is prevented, ameliorated or improved, wherein the
antibody or antigen-binding fragment comprises a heavy chain
variable region (HCVR) selected from the group consisting of SEQ ID
NO: 28, 44 and 48.
2. The method of claim 1, wherein the antibody or antigen-binding
fragment further comprises a light chain variable region (LCVR)
selected from the group consisting of SEQ ID NO: 36, 46 and 50.
3. The method of claim 2, wherein the HCVR and LCVR (HCVR/LCVR)
sequence pair is selected from the group consisting of SEQ ID NO:
28/36, 44/46 and 48/50.
4. The method of claim 3, wherein the HCVR/LCVR sequence pair is
SEQ ID NO: 48/50.
5. The method of claim 4, wherein the antibody or antigen-binding
fragment thereof is administered at a dose ranging from about 0.01
mg/kg of body weight to about 20 mg/kg of body weight.
6. The method of claim 5, wherein the antibody or antigen-binding
fragment thereof is administered at a dose ranging from about 0.03
mg/kg of body weight to about 3.0 mg/kg of body weight.
7. A method of treating, inhibiting or ameliorating at least one
symptom associated with osteoarthritis in a human subject in need
thereof, comprising administering to the subject a therapeutically
effective amount of an anti-human NGF antibody or antigen-binding
fragment thereof, wherein the antibody or antigen-binding fragment
thereof comprises a heavy and light chain complementary determining
region (HCDR and LCDR) from a HCVR/LCVR sequence pair selected from
the group consisting of SEQ ID NO: 28/36, 44/46 and 48/50.
8. The method of claim 7, wherein the CDRs are from the sequence
pair of SEQ ID NO: 48/50.
9. A method of treating, inhibiting or ameliorating at least one
symptom associated with osteoarthritis in a subject in need
thereof, comprising administering to the subject a therapeutically
effective amount of an antibody or antigen-binding fragment thereof
that binds specifically to human NGF, the antibody comprising a
HCDR3 domain of SEQ ID NO: 34, a LCDR3 domain of SEQ ID NO: 42, a
HCDR2 domain of SEQ ID NO: 32, a LCDR2 domain of SEQ ID NO: 40, a
HCDR1 domain of SEQ ID NO: 30 and a LCDR1 domain of SEQ ID NO:
38.
10. The method of claim 9, wherein the antibody or fragment thereof
is administered by subcutaneous or intravenous administration.
11. The method according to claim 9, further comprising
administering a second therapeutic agent, wherein the second
therapeutic agent is selected from the group consisting of a
non-steroidal anti-inflammatory drug (NSAID), an oral or injectable
glucocorticoid, an opioid, tramadol, an alpha-2-delta ligand and
hyaluronic acid.
Description
FIELD OF THE INVENTION
The present invention is related to therapeutic methods for
treating osteoarthritis in a human patient in need thereof, with an
antibody or antigen-binding fragment of an antibody specific for
human nerve growth factor (NGF) and pharmaceutical compositions
containing the antibody or antibody fragment.
STATEMENT OF RELATED ART
While numerous analgesic medications are currently available, the
adequate relief of pain remains an unmet medical need for many
acute and chronic pain states. The limitations of currently
available analgesic therapies include adverse central nervous
system (CNS) effects, nausea and vomiting, gastrointestinal (GI)
bleeding and ulceration, idiosyncratic cardiovascular events
attributed to drugs that suppress cyclooxygenase-2, renal toxicity,
abuse potential and others that span the spectrum of drug
toxicity.
Osteoarthritis is a progressive, chronic disease in which pain is
often a key limiting factor and for which acceptable long-term
therapy does not yet exist. Current long-term therapies such as
non-steroidal anti-inflammatory drugs (NSAIDs) and celecoxib can be
problematic due to specific side effects and potential health risks
such as GI bleeding and increased risk of cardiovascular events. In
addition, these medications must be taken daily to maintain their
analgesic effects. As the prevalence of OA in patients aged older
than 65 years is 60% in men and 70% in women and continually
rising, the search for additional treatment options with fewer
associated side-effects is ongoing.
Neurotrophins are a family of peptide growth factors that play a
role in the development, differentiation, survival and death of
neuronal and non-neuronal cells. The first neurotrophin to be
identified was nerve growth factor (NGF), and its role in the
development and survival of both peripheral and central neurons
during the developing nervous system has been well characterized.
In the adult, NGF is a pain mediator that sensitizes neurons and is
not required as a survival factor.
NGF activity is mediated through two different membrane-bound
receptors, the TrkA receptor and the p75 common neurotrophin
receptor. The NGF/TrkA system appears to play a major role in the
control of inflammation and pain, since it is upstream of several
relevant molecular pathways. Mast cells, for example, are capable
of producing NGF, but are also induced by NGF to release
inflammatory mediators. Nerve growth factor expression is known to
be upregulated in injured and inflamed tissues in conditions such
as cystitis, prostatitis, and chronic headache.
Selective antagonism of NGF by a fully-human high-affinity
monoclonal antibody (mAb) has the potential to be effective without
the adverse side effects of traditional analgesic drugs, since it
works through a different physiological mechanism of action. Human
genetic studies that show that people suffering from a loss of deep
pain perception have mutations in TrkA (HSAN IV) or NGF (HSAN V).
In addition, NGF is known to be elevated in the synovial fluid of
patients suffering from rheumatoid arthritis and other types of
arthritis.
Anti-NGF antibodies are described in, for example, EP1575517; WO
01/78698, WO 02/096458, WO 2004/032870; U.S. Pat. Nos. 7,601,818;
7,449,616; 7,655,232; US patent application publications
2009/0155274; 2009/0208490; 2008/033157; 2008/0107658;
2005/0074821; 2004/0237124, and 2004/0219144.
BRIEF SUMMARY OF THE INVENTION
In a first aspect, the invention features methods for preventing,
inhibiting, ameliorating and/or treating at least one of the
symptoms associated with osteoarthritis in a human subject in need
thereof, comprising administering to the subject a therapeutically
effective amount of a fully human anti-NGF antibody, or
antigen-binding fragment thereof, wherein at least one of the
symptoms of osteoarthritis is prevented, inhibited, ameliorated or
improved. In specific embodiments, the antibody or antigen-binding
fragment of an antibody to be used in the method of the invention
is a fully human antibody comprising heavy chain variable region
(HCVR) selected from the group consisting of SEQ ID NO: 4, 20, 24,
28, 44 and 48. In more specific embodiments, the HCVR is selected
from the group of SEQ ID NO: 20, 24 and 48. In one specific
embodiment, the HCVR is SEQ ID NO:24. In specific embodiments, the
antibody or antigen-binding fragment thereof to be used in the
present invention is a fully human antibody comprising light chain
variable region (LCVR) selected from the group consisting of SEQ ID
NO: 12, 22, 26, 36, 46 and 50. In more specific embodiments, the
LCVR is selected from the group of SEQ ID NO: 22, 26 and 50. In one
specific embodiment, the LCVR is SEQ ID NO:26.
In specific embodiments, the antibody or fragment thereof comprises
a HCVR and LCVR (HCVR/LCVR) sequence pair selected from the group
consisting of SEQ ID NO: 4/12, 20/22, 24/26, 28/36, 44/46 and
48/50. In more specific embodiments, the HCVR/LCVR sequence pair is
selected from the group consisting of SEQ ID NO: 20/22, 24/26 and
48/50. In one specific embodiment, the HCVR/LCVR sequence pair is
SEQ ID NO:24/26.
In a second aspect, the invention features a method of treating,
inhibiting, ameliorating, or reducing the occurrence of
osteoarthritis in a human subject in need thereof, comprising
administering to the subject a therapeutically effective amount of
an anti-human NGF antibody or antigen-binding fragment thereof,
wherein the antibody or antigen-binding fragment thereof comprises
heavy and light chain complementary determining regions (HCDR and
LCDR) from HCVR/LCVR sequence pairs selected from the group
consisting of SEQ ID NO: 4/12, 20/22, 24/26, 28/36, 44146 and
48/50. In more specific embodiments, the antibody or antibody
fragment comprise CDRs from HCVR/LCVR sequence pairs selected from
the group consisting of SEQ ID NO: 20/22, 24/26 and 48/50. In one
specific embodiment, the CDRs are from the sequence pair of SEQ ID
NO: 24/26. Methods and techniques for identifying CDRs within HCVR
and LCVR amino acid sequences are well known in the art and can be
used to identify CDRs within the specified HCVR and/or LCVR amino
acid sequences disclosed herein. Exemplary conventions that can be
used to identify the boundaries of CDRs include, e.g., the Kabat
definition, the Chothia definition, and the AbM definition. In
general terms, the Kabat definition is based on sequence
variability, the Chothia definition is based on the location of the
structural loop regions, and the AbM definition is a compromise
between the Kabat and Chothia approaches. See, e.g., Kabat,
"Sequences of Proteins of Immunological Interest," National
Institutes of Health, Bethesda, Md. (1991); Al-Lazikani et al., J.
Mol. Biol. 273:927-948 (1997); and Martin at al., Proc. Natl. Acad.
Sci. USA 86:9268-9272 (1989). Public databases are also available
for identifying CDR sequences within an antibody.
In one embodiment, the antibody or antigen-binding fragment thereof
comprises a heavy chain CDR3 (HCDR3) and a light chain CDR3
(LCDR3), wherein the HCDR3 comprises an amino acid sequence of the
formula
X.sup.1-X.sup.2-X.sup.3-X.sup.4-X.sup.5-X.sup.6-X.sup.7-X.sup.8-X.sup.9-X-
.sup.10-X.sup.11-X.sup.12-X.sup.13-X.sup.14-X.sup.15-X.sup.16-X.sup.17-X.s-
up.18 (SEQ ID NO:53) wherein X.sup.1 is Ala or Ser, X.sup.2 is Thr
or Lys, X.sup.3 is Glu or Ile, X.sup.4 is Phe or Gly, X.sup.5 is
Val or Gly, X.sup.8 is Val or Trp, X.sup.7 is Val or Phe, X.sup.8
is Thr or Gly, X.sup.9 is Asn or Lys, X.sup.10 is Phe or Leu,
X.sup.11 is Asp or Phe, X.sup.12 is Mn or Ser, X.sup.13 is Ser or
absent, X.sup.14 is Tyr or absent. X.sup.15 is Gly or absent,
X.sup.16 is Met or absent, X.sup.7 is Asp or absent, and X.sup.18
is Val or absent; and the LCDR3 comprises an amino acid sequence of
the formula
X.sup.1-X.sup.2-X.sup.3-X.sup.4-X.sup.5-X.sup.6-X.sup.7-X.sup.8-X.sup.9
(SEQ ID NO:56) wherein X.sup.1 is Gln, X.sup.2 is Gln, X.sup.3 is
Tyr, X.sup.4 is Asn, X.sup.5 is Arg or Asn, X.sup.6 is Tyr or Trp,
X.sup.7 is Pro, X.sup.8 is Tyr or Trp, and X.sup.9 is Thr.
In another embodiment, the antibody or antigen binding fragment
thereof further comprises a HCDR1 sequence comprising the formula
X.sup.1-X.sup.2-X.sup.3-X.sup.4-X.sup.5-X.sup.6-X.sup.7-X.sup.8
(SEQ ID NO:51), wherein X.sup.1 is Gly, X.sup.2 is Phe, X.sup.3 is
Thr or Asn, X.sup.4 is Phe or Leu, X.sup.5 is Thr or Asp, X.sup.6
is Asp or Glu, X.sup.7 is Tyr or Leu, and X.sup.8 is Ser or Ala; a
HCDR2 sequence comprising the formula
X.sup.1-X.sup.2-X.sup.3-X.sup.4-X.sup.5-X.sup.6-X.sup.7-X.sup.8
(SEQ ID NO:52), wherein X.sup.1 is Ile or Phe, X.sup.2 is Asp or
Ser, X.sup.3 is Pro or Trp, X.sup.4 is Glu or Asn, X.sup.5 is Asp
or Ser, X.sup.6 is Gly, X.sup.7 is Thr or Glu, X.sup.8 is Thr or
Ile; a LCDR1 sequence comprising the formula
X.sup.1-X.sup.2-X.sup.3-X.sup.4-X.sup.5-X.sup.6 (SEQ ID NO:54)
wherein X.sup.1 is Gin, X.sup.2 is Ala or Ser, X.sup.3 is Val or
Ile, X.sup.4 is Arg or Thr, X.sup.5 is Asn or Tyr, and X.sup.8 is
Asp or Asn; and a LCDR2 sequence comprising the formula
X.sup.1-X.sup.2-X.sup.3 (SEQ ID NO:55) wherein X.sup.1 is Gly or
Ala, X.sup.2 is Ala, and X.sup.3 is Ser or Phe.
In a third aspect, the invention features a method of treating,
inhibiting or ameliorating osteoarthritis in a subject in need
thereof, or at least one symptom associated with osteoarthritis,
comprising administering to the subject a therapeutically effective
amount an antibody or antigen-binding fragment thereof comprising a
HCDR3 selected from the group consisting of SEQ ID NO: 10 and 34,
and a LCDR3 selected from the group consisting of SEQ ID NO: 18 and
42. In a more specific embodiment, the HCDR3/LCDR3 are selected
from the sequence pair groups consisting of SEQ ID NO: 10/18 and
34/42.
In a further embodiment, the antibody or fragment thereof comprises
heavy chain CDRs (HCDR1, HCDR2 and HCDR3) and light chain CDRs
(LCDR1, LCDR2 and LCDR3) selected from the group consisting of SEQ
ID NO: 6, 8, 10, 30, 32, 34; and 14, 16, 18, 38, 40, 42,
respectively. In one embodiment, the antibody or fragment thereof
comprises CDR sequences SEQ ID NO: 6, 8, 10, 14, 16 and 18.
In various embodiments of a method of the invention, administration
of the antibody or antigen-binding fragment of an antibody is by,
for example, subcutaneous or intravenous administration, or
administration locally at the site of disease.
In a fourth aspect, the invention features a method of treating,
inhibiting, ameliorating, or reducing the occurrence of
osteoarthritis in a subject in need thereof, or at least one
symptom associated with osteoarthritis, comprising administering to
the subject a therapeutically effective amount of an antibody or
antigen binding fragment thereof in combination with a second
therapeutic agent. Examples of a second therapeutic agent having
applications in the method of the present invention include, but
are not limited to, a second NGF antibody, anon-steroidal
anti-inflammatory drug (NSAID), an oral or injectable
glucocorticoid, an opioid, tramadol, an alpha-2-delta ligand and
hyaluronic acid.
In one embodiment, an antibody or antigen-binding fragment thereof
having applications in a method of the present invention is
administered as an initial dose of at least approximately about 0.1
mg to about 800 mg. In certain embodiments, an antibody or
antigen-binding fragment thereof having applications in a method of
the present invention is administered as an initial dose of at
least approximately about 5 to about 100 mg. In other embodiments,
an antibody or antigen-binding fragment thereof having applications
in a method of the present invention is administered as an initial
dose of at least approximately about 10 to about 50 mg. In specific
embodiments, the initial dose may be followed by administration of
a second or a plurality of subsequent doses of the antibody or
antigen-binding fragment thereof in an amount that is approximately
the same or less than that of the initial dose, wherein the
subsequent doses are separated by at least one day; at least one
week, at least 2 weeks; at least 3 weeks; at least 4 weeks; at
least 5 weeks; at least 6 weeks; at least 7 weeks; at least 8
weeks; at least 9 weeks; at least 10 weeks; at least 12 weeks; or
at least 14 weeks.
A particular example of an antibody or antigen-binding fragment
thereof having applications in a method of the present invention is
mAb1 (HCVR/LCVR SEQ ID NO:24/26).
BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 shows the clinical study flowchart.
DETAILED DESCRIPTION
Before the present methods are described, it is to be understood
that this invention is not limited to particular methods, and
experimental conditions described, as such methods and conditions
may vary. It is also to be understood that the terminology used
herein is for the purpose of describing particular embodiments
only, and is not intended to be limiting, since the scope of the
present invention will be defined in and limited only by the
appended claims.
Unless defined otherwise, all technical and scientific terms used
herein have the same meaning as commonly understood by one of
ordinary skill in the art to which this invention belongs. Although
any methods and materials similar or equivalent to those described
herein can be used in the practice or testing of the present
invention, preferred methods and materials are now described. All
publications mentioned herein are incorporated herein by reference
in their entirety.
Anti-NGF Antibodies and Antigen-Binding Fragments Thereof
The method of the invention relates to the use of an anti-NGF
antibody or antibody fragment that specifically binds NGF. The term
"human nerve growth factor" or "NGF", as used herein, refers to
human NGF having the nucleic acid sequence shown in SEQ ID NO:1 and
the amino acid sequence of SEQ ID NO:2, or a biologically active
fragment thereof.
The term "specifically binds," means that an antibody or
antigen-binding fragment thereof forms a complex with an antigen
that is relatively stable under physiologic conditions. Specific
binding can be characterized by a equilibrium dissociation constant
of about 1.times.10.sup.-6 M or smaller. Methods for determining
whether two molecules specifically bind are well known in the art
and include, for example, equilibrium dialysis, surface plasmon
resonance, and the like.
An "antibody" is an immunoglobulin molecule comprised of four
polypeptide chains, two heavy (H) chains and two light (L) chains
inter-connected by disulfide bonds. Each heavy chain is comprised
of a heavy chain variable region ("HCVR" or "V.sub.H") and a heavy
chain constant region (C.sub.H) comprised of three domains,
C.sub.H1, C.sub.H2 and C.sub.H3. Each light chain is comprised of a
light chain variable region ("LCVR or V.sub.L") and a light chain
constant region (C.sub.L. The light chain constant region is
comprised of one domain, C.sub.L. The V.sub.H and V.sub.L regions
can be further subdivided into regions of hypervariability, termed
complementarity determining regions (CDR), interspersed with
regions that are more conserved, termed framework regions (FR).
Each HCVR and LCVR is composed of three CDRs and four FRs, arranged
from amino-terminus to carboxy-terminus in the following order:
FR1, CDR1, FR2, CDR2, FR3, CDR3, FR4. In certain embodiments of the
invention, the FRs of the anti-NGF antibody (or antigen binding
fragment thereof) may be identical to the human germline sequences,
or may be naturally or artificially modified. An amino acid
consensus sequence may be defined based on a side-by-side analysis
of two or more CDRs.
The fully-human anti-NGF antibodies disclosed herein may comprise
one or more amino acid substitutions, insertions and/or deletions
in the framework and/or CDR regions of the heavy and light chain
variable domains as compared to the corresponding germline
sequences. Such mutations can be readily ascertained by comparing
the amino acid sequences disclosed herein to germline sequences
available from, for example, public antibody sequence databases.
The present invention includes antibodies, and antigen-binding
fragments thereof, which are derived from any of the amino acid
sequences disclosed herein, wherein one or more amino acids within
one or more framework and/or CDR regions are mutated to the
corresponding residue(s) of the germline sequence from which the
antibody was derived, or to the corresponding residue(s) of another
human germline sequence, or to a conservative amino acid
substitution of the corresponding germline residue(s) (such
sequence changes are referred to herein collectively as "germline
mutations"). A person of ordinary skill in the art, starting with
the heavy and light chain variable region sequences disclosed
herein, can easily produce numerous antibodies and antigen-binding
fragments which comprise one or more individual germline mutations
or combinations thereof. In certain embodiments, all of the
framework and/or CDR residues within the V.sub.H and/or V.sub.L
domains are mutated back to the residues found in the original
germline sequence from which the antibody was derived. In other
embodiments, only certain residues are mutated back to the original
germline sequence, e.g., only the mutated residues found within the
first 8 amino acids of FR1 or within the last 8 amino acids of FR4,
or only the mutated residues found within CDR1, CDR2 or CDR3. In
other embodiments, one or more of the framework and/or CDR
residue(s) are mutated to the corresponding residue(s) of a
different germline sequence (i.e., a germline sequence that is
different from the germline sequence from which the antibody was
originally derived). Furthermore, the antibodies of the present
invention may contain any combination of two or more germline
mutations within the framework and/or CDR regions, e.g., wherein
certain individual residues are mutated to the corresponding
residue of a particular germline sequence while certain other
residues that differ from the original germline sequence are
maintained or are mutated to the corresponding residue of a
different germline sequence. Once obtained, antibodies and
antigen-binding fragments that contain one or more germline
mutations can be easily tested for one or more desired property
such as, improved binding specificity, increased binding affinity,
improved or enhanced antagonistic or agonistic biological
properties (as the case may be), reduced immunogenicity, etc.
Antibodies and antigen-binding fragments obtained in this general
manner are encompassed within the present invention.
The present invention also includes anti-NGF antibodies comprising
variants of any of the HCVR, LCVR, and/or CDR amino acid sequences
disclosed herein having one or more conservative substitutions. For
example, the present invention includes anti-NGF antibodies having
HCVR, LCVR, and/or CDR amino acid sequences with, e.g., 20 or
fewer, 10 or fewer, 8 or fewer, 6 or fewer, 4 or fewer, etc.
conservative amino acid substitutions relative to any of the HCVR,
LCVR, and/or CDR amino acid sequences disclosed herein.
The term "antigen-binding fragment" of an antibody (or
"antibody-binding portion"), as used herein, refers to one or more
fragments of an antibody that retain the ability to specifically
bind to an antigen (e.g., NGF). An antibody fragment may include,
for example, a Fab fragment, a F(ab').sub.2 fragment, a Fv
fragment, a dAb fragment, a fragment containing a CDR, or an
isolated CDR.
In certain embodiments, an antibody or antibody fragment of the
invention may be conjugated to a therapeutic moiety
("immunoconjugate"), such as a cytotoxin, a chemotherapeutic drug,
an immunosuppressant or a radioisotope. A therapeutic moiety that
is a cytotoxin includes any agent that is detrimental to cells.
In certain embodiments, the antibody or antibody fragment for use
in the method of the invention may be monospecific, bispecific, or
multispecific. Multispecific antibodies may be specific for
different epitopes of one target polypeptide or may contain
antigen-binding domains specific for epitopes of more than one
target polypeptide. An exemplary bi-specific antibody format that
can be used in the context of the present invention involves the
use of a first immunoglobulin (Ig) C.sub.H3 domain and a second Ig
C.sub.H3 domain, wherein the first and second Ig C.sub.H3 domains
differ from one another by at least one amino acid, and wherein at
least one amino acid difference reduces binding of the bispecific
antibody to Protein A as compared to a bi-specific antibody lacking
the amino acid difference. In one embodiment, the first Ig C.sub.H3
domain binds Protein A and the second Ig C.sub.H3 domain contains a
mutation, such as an H95R modification (by IMGT exon numbering;
H435R by EU numbering), which reduces or abolishes Protein A
binding. The second C.sub.H3 may further comprise an Y96F
modification (by IMGT; Y436F by EU). Further modifications that may
be found within the second C.sub.H3 include: D16E, L18M, N44S,
K52N, V57M, and V82I (by IMGT; D356E, L358M, N384S, K392N, V397M,
and V422I by EU) in the case of IgG1 antibodies; N44S, K52N, and
V82I (IMGT; N384S, K392N, and V422I by EU) in the case of IgG2
antibodies; and Q15R, N44S, K52N, V57M, R69K, E79Q, and V82I (by
IMGT; Q355R, N384S, K392N, V397M, R409K, E419Q, and V422I by EU) in
the case of IgG4 antibodies. Variations on the bi-specific antibody
format described above are contemplated within the scope of the
present invention.
Therapeutic Administration and Formulations
The invention provides methods of using therapeutic compositions
comprising anti-NGF antibodies or antigen-binding fragments
thereof. The therapeutic compositions of the invention will be
administered with suitable carriers, excipients, and other agents
that are incorporated into formulations to provide improved
transfer, delivery, tolerance, and the like. A multitude of
appropriate formulations are available to the skilled artisan such
as those that can be found in the formulary known to all
pharmaceutical chemists: Remington's Pharmaceutical Sciences, Mack
Publishing Company, Easton, Pa. These formulations include, for
example, powders, pastes, ointments, jellies, waxes, oils, lipids,
lipid (cationic or anionic) containing vesicles (such as
LIPOFECTIN.TM.), DNA conjugates, anhydrous absorption pastes,
oil-in-water and water-in-oil emulsions, emulsions carbowax
(polyethylene glycols of various molecular weights), semi-solid
gels, and semi-solid mixtures containing carbowax. See also Powell
et al. "Compendium of excipients for parenteral formulations" FDA
(1998) J Pharm Sci Technol 52:238-311.
The dose may vary depending upon the age and the weight of a
subject to be administered, target disease, conditions, route of
administration, and the like. When the antibody of the present
invention is used for treating various conditions and diseases
associated with NGF, including inflammatory pain, neuropathic
and/or nociceptive pain, hepatocellular carcinoma, breast cancer,
liver cirrhosis, and the like, in an adult patient, it is
advantageous to administer the antibody of the present invention
either intravenously or subcutaneously, normally at a single dose
of about 0.01 to about 20 mg/kg body weight, more preferably about
0.02 to about 7, about 0.03 to about 5, or about 0.05 to about 3
mg/kg body weight. Depending on the severity of the condition, the
frequency and the duration of the treatment can be adjusted.
Various delivery systems are known and can be used to administer
the pharmaceutical composition of the invention, e.g.,
encapsulation in liposomes, microparticles, microcapsules, receptor
mediated endocytosis (see. e.g., Wu et al. (1987) J. Biol. Chem.
262:4429-4432). Methods of introduction include, but are not
limited to, intradermal, intramuscular, intraperitoneal,
intravenous, subcutaneous, intranasal, epidural, and oral routes.
The composition may be administered by any convenient route, for
example by infusion or bolus injection, by absorption through
epithelial or mucocutaneous linings (e.g., oral mucosa, rectal and
intestinal mucosa, etc.) and may be administered together with
other biologically active agents. Administration can be systemic or
local.
The pharmaceutical composition can also be delivered in a vesicle,
in particular a liposome (see Langer (1990) Science 249:1527-1533).
In certain situations, the pharmaceutical composition can be
delivered in a controlled release system, for example, with the use
of a pump or polymeric materials. In another embodiment, a
controlled release system can be placed in proximity of the
composition's target, thus requiring only a fraction of the
systemic dose.
The injectable preparations may include dosage forms for
intravenous, subcutaneous, intracutaneous and intramuscular
injections, local injection, drip infusions, etc. These injectable
preparations may be prepared by methods publicly known. For
example, the injectable preparations may be prepared, e.g., by
dissolving, suspending or emulsifying the antibody or its salt
described above in a sterile aqueous medium or an oily medium
conventionally used for injections. As the aqueous medium for
injections, there are, for example, physiological saline, an
isotonic solution containing glucose and other auxiliary agents,
etc., which may be used in combination with an appropriate
solubilizing agent such as an alcohol (e.g., ethanol), a
polyalcohol (e.g., propylene glycol, polyethylene glycol), a
nonionic surfactant [e.g., polysorbate 80, HCO-50 (polyoxyethylene
(50 mol) adduct of hydrogenated castor oil)], etc. As the oily
medium, there are employed, e.g., sesame oil, soybean oil, etc.,
which may be used in combination with a solubilizing agent such as
benzyl benzoate, benzyl alcohol, etc. The injection thus prepared
is preferably filled in an appropriate ampoule.
A pharmaceutical composition of the present invention can be
delivered subcutaneously or intravenously with a standard needle
and syringe. In addition, with respect to subcutaneous delivery, a
pen delivery device readily has applications in delivering a
pharmaceutical composition of the present invention. Such a pen
delivery device can be reusable or disposable. A reusable pen
delivery device generally utilizes a replaceable cartridge that
contains a pharmaceutical composition. Once all of the
pharmaceutical composition within the cartridge has been
administered and the cartridge is empty, the empty cartridge can
readily be discarded and replaced with a new cartridge that
contains the pharmaceutical composition. The pen delivery device
can then be reused. In a disposable pen delivery device, there is
no replaceable cartridge. Rather, the disposable pen delivery
device comes prefilled with the pharmaceutical composition held in
a reservoir within the device. Once the reservoir is emptied of the
pharmaceutical composition, the entire device is discarded.
Numerous reusable pen and autoinjector delivery devices have
applications in the subcutaneous delivery of a pharmaceutical
composition of the present invention. Examples include, but
certainly are not limited to AUTOPEN.TM. (Owen Mumford, Inc.
Woodstock, UK), DISETRONIC.TM. pen (Disetronic Medical Systems,
Burghdorf, Switzerland), HUMALOG MIX 75/25.TM. pen, HUMALOG.TM.
pen, HUMALIN 70/30.TM. pen (Eli Lilly and Co., Indianapolis, Ind.),
NOVOPEN.TM. I, II and III (Novo Nordisk, Copenhagen, Denmark),
NOVOPEN JUNIOR.TM. (Novo Nordisk, Copenhagen, Denmark), BD.TM. pen
(Becton Dickinson, Franklin Lakes, N.J.), OPTIPEN.TM., OPTIPEN
PRO.TM., OPTIPEN STARLET.TM., and OPTICLIK.TM. (Sanofi-Aventis,
Frankfurt, Germany), to name only a few. Examples of disposable pen
delivery devices having applications in subcutaneous delivery of a
pharmaceutical composition of the present invention include, but
certainly are not limited to the SOLOSTAR.TM. pen (Sanofi-Aventis),
the FLEXPEN.TM. (Novo Nordisk), and the KWIKPEN.TM. (Eli Lilly),
the SURECLICK.TM. Autoinjector (Amgen, Thousands Oaks, Calif.), the
PENLET.TM. (Haselmeier, Stuttgart, Germany), the EPIPEN (Dey, L.P.)
and the HUMIRA.TM. Pen (Abbott Labs, Abbott Park, Ill.), to name
only a few.
Advantageously, the pharmaceutical compositions for oral or
parenteral use described above are prepared into dosage forms in a
unit dose suited to fit a dose of the active ingredients. Such
dosage forms in a unit dose include, for example, tablets, pills,
capsules, injections (ampoules, pre-filled syringes or
auto-injectors), suppositories, etc. The amount of the aforesaid
antibody contained is generally about 0.1 to 800 mg per dosage form
in a unit dose; especially in the form of injection, it is
preferred that the aforesaid antibody is contained in about 1 to
250 mg or about 10 to 100 mg for the other dosage forms.
By the phrase "therapeutically effective amount" is meant an amount
that produces the desired effect for which it is administered. The
exact amount will depend on the purpose of the treatment, and will
be ascertainable by one skilled in the art using known techniques
(see, for example, Lloyd (1999) The Art, Science and Technology of
Pharmaceutical Compounding).
In specific embodiments of the therapeutic methods of the
invention, a subject suffering from osteoarthritis may be treated
with a combination of an antibody or antibody fragment of the
invention and optionally with at least a second therapeutic agent.
Examples of a second therapeutic agent having applications in a
method of the present invention include, but are not limited to, a
non-steroidal anti-inflammatory drug (NSAID), an oral or injectable
glucocorticoid, an opioid, tramadol, an alpha-2-delta ligand or
hyaluronic acid.
EXAMPLES
The following examples are put forth so as to further provide those
of ordinary skill in the art with a complete disclosure and
description of how to make and use the methods and compositions of
the invention, and are not intended to limit the scope of what the
inventors regard as their invention. Efforts have been made to
ensure accuracy with respect to numbers used (e.g., amounts,
temperature, etc.) but some experimental errors and deviations
should be understood. Unless indicated otherwise, parts are parts
by weight, molecular weight is average molecular weight,
temperature is in degrees Centigrade, and pressure is at or near
atmospheric. The statistical analyses were conducted according to
mixed Factorial ANOVA with Bondferroni post hoc or Tukey HSD post
hoc tests.
Example 1
Study of Anti-NGF Antibody in Patients with Osteoarthritis of the
Knee
A double-blind study in which patients with osteoarthritis (OA) of
the knee are randomized to 1 of 4 treatment arms (3 active and 1
placebo) was conducted. Randomization was stratified by Baseline
walking knee pain score (>7 and .ltoreq.7). Each patient
received a dose of a fully human anti-NGF mAb (mAb1) or placebo at
baseline (Day 1) and at week 8 (Day 57) for a total of 2 doses.
The doses evaluated were 0.03, 0.1, or 0.3 mg/kg administered
intravenously (IV). Approximately 53 patients were enrolled in each
treatment arm.
Patients of the target population were asked to discontinue their
current pain medications prior to the baseline visit and for the
duration of the study (end of week 24 [Day 169]). Rescue medication
(acetaminophen) was allowed during this time (a maximum of 4 g per
day, but not for more than 4 consecutive days). Low-dose aspirin
(up to 325 mg/day) was also allowed. The duration of the washout
period prior to baseline (Day 1) was determined by the half-life of
the medication (approximately 5 half-lives).
Patients received study drug on Day 1 (baseline) and at week 8 (Day
57). Patients were followed for 16 weeks after the second infusion,
until the end of week 24 (Day 169), for a total study duration of
24 weeks for each patient.
Safety and tolerability of mAb1 was assessed by evaluating the
incidence of treatment-emergent adverse events (TEAEs) from Day 1
to the end of week 24 (Day 169) or study withdrawal, by patient
medical history, physical examination, monitoring of vital signs
and ECGs, clinical laboratory testing, and neurological assessments
of sensory (tactile, pain, and vibration) and motor (muscle
strength, and reflex) function.
The effect of mAb1 on walking knee pain was assessed using the
numerical rating scale (NRS). Patients were asked to report the
average intensity of their walking knee pain daily for the duration
of the 24-week study. Changes in OA status were assessed using the
WOMAC (pain, stiffness and function subscales). The patient's
assessment of overall treatment effect was assessed by the Patient
Global Impression of Change (PGIC). The patient's assessment of
quality of life (QOL) was assessed using the SF-12 Scale.
Serum samples were collected for PK analysis, anti-mAb1 antibody
evaluation, and exploratory proteomic and gene expression (RNA)
analysis.
Patients completed the study when they received 2 doses of mAb1 or
placebo and completed all scheduled safety and efficacy assessments
to week 24 (Day 169).
Target Population.
Eligible patients for this study were men and women between 40 and
75 years of age, with a diagnosis of OA of the knee and who have
experienced moderate to severe knee pain for an average period of a
.gtoreq.3 months.
Inclusion Criteria.
A patient met the following criteria, to be eligible for inclusion
in the study: (1) Men and women .gtoreq.40 and .ltoreq.75 years of
age; (2) Diagnosis of OA of the knee according to American College
of Rheumatology (ACR) criteria, and experiencing moderate to severe
pain in the index knee for at least 3 months prior to the screening
visit; (3) Kellgren-Lawrence grade 2-3 radiographic severity of the
index knee at or within 6 months prior to Screening; (4) No new
chronic medications introduced within the past 30 days. This
criterion does not apply to the use of acetaminophen as rescue
medication; (5) Walking knee pain levels at Screening and Baseline
.gtoreq.4 on the NRS; (6) Willingness to discontinue currently used
pain medications (for 5 half-lives) prior to the baseline visit and
throughout the study; (7) Body weight <110 kg; (8) Willing, and
able to return for all clinic visits and complete all study-related
procedures; (9) Able to read and understand and willing to sign the
informed consent form; (10) Able to read, understand, and complete
study-related questionnaires.
Exclusion Criteria.
A patient who met any of the following criteria was excluded from
the study: (1) Significant concomitant illness including, but not
limited to, cardiac, renal, neurological, endocrinological,
metabolic or lymphatic disease that would adversely affect the
patient's participation in the study; (2) Patients with joint
replacement in the affected knee; (3) Patients with peripheral
neuropathy due to any reason; (4) Known Human Immunodeficiency
Virus (HIV) antibody, Hepatitis B surface antigen (HBsAg), and/or
Hepatitis C antibody (HCV) at the screening visit by history or
testing; (5) Known sensitivity to doxycycline or mAb therapeutics;
(6) Other medical or psychiatric conditions that could, in the
opinion of the Investigator or Sponsor, compromise protocol
participation; (7) Participation in any clinical research study
evaluating another investigational drug or therapy within 3 weeks
or at least 5 half-lives, whichever was longer, of the
investigational drug, prior to the screening visit; (8) Previous
exposure to an anti-NGF antibody; (9) Women who are pregnant or
nursing; (10) Sexually active men or women of childbearing
potential who were unwilling to practice adequate contraception
during the study (adequate contraceptive measures included stable
use of oral contraceptives or other prescription pharmaceutical
contraceptives for 2 or more cycles prior to screening;
intrauterine device [IUD]; bilateral tubal ligation: vasectomy;
condom or diaphragm plus either contraceptive sponge, foam or
jelly); (11) Women of childbearing potential who had either a
positive serum pregnancy test result at screening or a positive
urine pregnancy test result at baseline. (Women had to be
amenorrheic for at least 12 months in order to be considered
post-menopausal); (12) Current or prior substance abuse, alcohol
abuse, or abuse of prescription pain medication.
Investigational Treatment.
Sterile mAb1 Drug Product 20 mg/ml was provided in an aqueous
buffered vehicle, pH 5.0, containing 10 mM acetate, 20% (w/v)
sucrose and 1% (w/v) PEG 3500. Drug was supplied in a 5 ml glass
vial.
Reference Treatment.
Placebo was supplied in matched vials containing the same volume of
aqueous buffered vehicle (pH 5.0), but with no active protein.
Dose Administration and Schedule.
Study drug (mA1 or placebo) was administered on baseline (Day 1)
and at week 8 (Day 57). Prior to IV administration, the pharmacist
or designee withdrew the required amount of study drug (depending
on the patient's dose and weight) from a single-use vial and
injected it into an infusion bag of normal saline for infusion.
Calculations to determine the volume to be withdrawn were provided
in the Site Study Manual.
Method of Treatment Assignment.
Randomization was in a 1:1:1:1 ratio between the 4 treatment arms.
On Day 1, patients were randomized to receive either mAb1 at a dose
of 0.03 mg/kg, 0.1 mg/kg, 0.3 mg/kg, or placebo (in a 1:1:1:1
ratio) according to a pre-determined central randomization scheme.
Randomization was stratified by baseline walking knee pain scores
(>7 and .ltoreq.7).
Data Collection.
Study assessments and procedures are shown in the Study Flowchart
(FIG. 1). For early termination patients, all week 24
(End-of-study) assessments were performed when the patient returned
to the clinic for the final visit. All visits after Day 1 were
scheduled within a .+-.2-day window. X-Ray of knee affected with OA
(semi-flexed) was taken only if existing film was not available
within 6 months of screening date. At baseline (Day 1) and on Day
57, vital signs were measured immediately prior to dosing, at
15-minute intervals during the infusion, at the end of the
infusion, and 1, 2, and 4 hours after the completion of the
infusion. Average walking knee pain was assessed at all clinic
visits using the NRS. In-between visits, patients were asked to
report the average intensity of their walking knee pain DAILY via
the IVRS. On Day 1 and week 8 (Day 57), samples were collected
prior to the start of the infusion, immediately post-infusion, and
at 1, 2, and 4 hours post-infusion.
Visit Descriptions.
Screening/Day -14 to -3: Informed consent was obtained before
performing or initiating any study-related procedures. The
following information was collected: Inclusion/exclusion criteria;
Demographics; Medical history and concurrent illnesses including
any pre-dose symptoms or ongoing AEs; Concomitant medications; The
following procedures and assessments were conducted: X-Ray of knee
affected with OA (semi-flexed) which was taken only if an existing
film was not available within 6 months prior to screening; Physical
examination; Vital signs, height and weight; ECG; Serum pregnancy
test for women of childbearing potential; Hematology; Serum
Chemistry; Urinalysis. After screening was completed and a patient
was deemed eligible to participate, a discussion was held with the
patient to discuss the need to stop their current analgesic
medications for a specified number of days prior to the baseline
visit. The duration of this washout period was based upon the
half-life of the medication(s). In addition, patients were told
that they must remain off their medications for the duration of the
study.
Treatment Period.
Baseline/Day 1: At this visit subjects were randomized to a study
treatment and received either study drug or placebo. The following
information was collected prior to the administration of study
drug: Concomitant medications; Presence of any AEs; The following
procedures and assessments were conducted prior to the
administration of study drug: Vital signs (measured immediately
prior to dosing, at 15-minute intervals during the infusion, at the
end of the infusion, and 1, 2, and 4 hours post infusion); Urine
pregnancy test for women of childbearing potential; Hematology;
Serum Chemistry; Urinalysis; Neurological evaluation; Walking knee
pain; WOMAC; QOL Questionnaire; Blood sample collection for PK
analysis (samples were collected prior to infusion, immediately
post-infusion, and at 1, 2 and 4 hours post infusion); Blood sample
for anti-mAb1 antibody assessment; Blood sample for exploratory
proteomic and gene expression (RNA) analysis; Instruction in use of
IVRS.
Week 18Day 8 (.+-.2 Days).
The following information was collected: Concomitant medications;
Presence of any AEs. The following procedures and assessments were
conducted: Vital signs; Neurological evaluation; Walking knee pain;
WOMAC; Patient Global Impression of Change; Blood sample collection
for PK analysis; Blood sample for exploratory proteomic and gene
expression (RNA) analysis; Review of compliance with IVRS.
Week 2/Day 15 (.+-.2 Days).
The following information was collected: Concomitant medications;
Presence of any AEs. The following procedures and assessments were
completed: Vital signs; Neurological Evaluation; Walking knee pain;
WOMAC; Blood sample collection for PK analysis; Review of
compliance with IVRS.
Week 4/Day 29 (.+-.2 Days).
The following information was collected: Concomitant medications;
Presence of any AEs. The following procedures and assessments were
conducted: Vital signs; Hematology; Serum Chemistry; Urinalysis;
Neurological evaluation; Walking knee pain; WOMAC; Patient Global
Impression of Change; QOL Questionnaire; Blood sample collection
for PK analysis; Blood sample for exploratory proteomic and gene
expression (RNA) analysis; Review of compliance with IVRS.
Week 8/Day 57 (.+-.2 Days).
Patients received the second dose of study drug on Day 57. Prior to
receiving study drug, the following information was collected:
Concomitant medications; Presence of any AEs; The following
procedures and assessments were also conducted prior to the
administration of study drug: Physical examination; Vital signs and
weight (vital signs measured immediately prior to dosing, at
15-minute intervals during the infusion, at the end of the
infusion, and 1, 2, and 4 hours post infusion); ECG; Urine
pregnancy test for women of childbearing potential; Hematology;
Serum Chemistry; Urinalysis; Neurological evaluation; Walking knee
pain; WOMAC; Patient Global Impression of Change; QOL
Questionnaire; Blood sample collection for PK analysis (samples
were collected prior to infusion, immediately post-infusion, and at
1, 2 and 4 hours post infusion); Blood sample for mAb1 antibody
assessment; Blood sample for exploratory proteomic and gene
expression (RNA) analysis; Review of compliance with IVRS.
Week 10/Day 71 (.+-.2 Days).
The following information was collected: Concomitant medications;
Presence of any AEs. The following procedures and assessments were
conducted: Vital signs; Neurological evaluation; Walking knee pain;
WOMAC; Blood sample collection for PK analysis; Review of
compliance with IVRS.
Week 12/Day 85 (.+-.2 Days).
The following information was collected: Concomitant medications;
Presence of any AEs. The following procedures and assessments were
conducted: Vital signs; Hematology; Serum Chemistry; Urinalysis;
Neurological valuation; Walking knee pain; WOMAC; Patient Global
Impression of Change; QOL Questionnaire; Blood sample collection
for PK analysis; Blood sample for mAb1 antibody assessment; Blood
sample for exploratory proteomic and gene expression (RNA)
analysis; Review of compliance with IVRS. Week 1'6/Day 113 (.+-.2
days). The following information was collected: Concomitant
medications; Presence of any AEs. The following procedures and
assessments were conducted: Vital signs; Hematology; Serum
Chemistry; Urinalysis; Neurological evaluation; Walking knee pain;
WOMAC; Patient Global Impression of Change; QOL Questionnaire;
Blood sample collection for PK analysis; Review of compliance with
IVRS.
Week 20/Day 141 (.+-.2 Days).
The following information was collected: Concomitant medications;
Presence of any AEs. The following procedures and assessments were
conducted: Vital signs; Hematology; Serum Chemistry; Urinalysis;
Neurological evaluation; Walking knee pain; WOMAC; Patient Global
Impression of Change; QOL Questionnaire; Blood sample collection
for PK analysis; Review of compliance with IVRS.
End of Study Assessments (Week 24/Day 169) (.+-.2 Days).
The following information was collected during the end-of-study
visit: Concomitant medications; Presence of any AEs. The following
procedures and assessments were conducted; Physical examination;
Vital signs and weight; ECG; Urine pregnancy test for women of
childbearing potential; Hematology; Serum Chemistry; Urinalysis;
Neurological evaluation; Walking knee pain; WOMAC: Patient Global
Impression of Change; QOL Questionnaire; Blood sample collection
for PK analysis; Blood sample for anti-mAb1 antibody assessment;
Blood sample for exploratory proteomic and gene expression (RNA)
analysis; Review of compliance with IVRS.
Walking Knee Pain.
The key efficacy endpoint in this study was the mean change from
baseline in walking knee pain using the NRS at each study visit
until Week 24. The baseline value was defined as the NRS value from
Visit 2 and the weekly NRS value up to Week 24 (End of Study [EOS])
were defined as the average of daily assessments measured during
the week. Patients reviewed the intensity of their knee pain with
the appropriate study site personnel during their scheduled clinic
visits and this information was recorded in the eCRF. Patients were
also asked to record the average intensity of their walking knee
pain daily, using the IVRS system, during their participation in
the study. Daily assessment and recording of walking knee pain was
performed at the same time each day when possible. The Numerical
Rating Scale (NRS) instructed the patient to rate their pain on a
0-10 pain rating scale, 0 means no pain and 10 means the worst
possible pain. The middle of the scale (around 5) was considered to
be moderate pain. A value of 2 or 3 was considered to be mild pain,
but a value of 7 or higher was considered to be severe pain.
Western Ontario and McMaster Osteoarthritis Index (WOMAC).
The WOMAC Index was used to assess patients with OA of the hip or
knee using 24 parameters in three areas: pain (5 items), stiffness
(2 items), and function (17 items). It can be used to monitor the
course of a disease or to determine effectiveness of medications.
Patients completed the WOMAC (pain, stiffness and function
subscales) at baseline (Day 1), week 1 (Day 8), week 2 (Day 15),
week 4 (Day 29), week 8 (Day 57), week 10 (Day 71), week 12 (Day
85), week 16 (Day 113), week 20 (Day 141), and at the end-of-study
(week 24 [Day 169]). Patients were asked to score each of the 24
parameters using the scale shown in Table 1. The patient was asked
to rate each statement on a Likert item, ranging from 0 (none) to
10 (extreme). Pain dimension subscale was calculated as the average
score of Q1 to Q5 (Thumboo et al (2001), Osteoarthritis Cartilage,
July; 9(5):440-6.). Stiffness dimension subscale was calculated as
the average score of Q6 and Q7. Function dimension subscale was
calculated as the average score of Q8 to Q24. Standardized total
scale will be calculated as the average score from all 24
questions. Change from baseline in the above subscales and the
standardized total scale to each measurement visit was
analyzed.
TABLE-US-00001 TABLE 1 Response Points none 0 slight 1 moderate 2
severe 3 extreme 4
WOMAC parameters: Pain: 1. Walking on a fiat surface; 2. Stair
climbing; 3. Nocturnal (at night, lying in bed); 4. Rest (sitting
or lying down); 5. Weight bearing (standing upright). Stiffness: 6.
Morning stiffness; 7. Stiffness occurring later in the day.
Function: 8. Difficulty descending stairs; 9. Difficulty ascending
stairs; 10. Rising from sitting; 11. Standing; 12. Bending to floor
(to pick something up): 13. Walking on a flat surface; 14. Getting
in or out of car; 15. Going shopping; 16. Putting on socks; 17.
Rising from bed; 18. Taking off socks; 19. Lying in bed; 20.
Getting in and out of the bathtub; 21. Difficulty sitting (for a
period of time); 22. Getting on or off toilet; 23. Heavy domestic
duties; 24. Light domestic duties.
Patient Global Impression of Change (PGIC).
The PGIC is a patient-rated assessment of response to treatment on
a 7-point Likert scale and was completed at week 1 (Day 8), week 4
(Day 29), week 8 (Day 57), week 12 (Day 85), week 16 (Day 113),
week 20 (Day 141), and at the end-of-study (week 24 [Day 169]). The
recall period for this scale was 1 week. The patient responded to
the question "Compared to a week ago, how would you rate your
overall status?" by selecting an option from 1. Very Much Improved:
2. Much Improved; 3. Minimally Improved; 4. No Change; 5. Minimally
Worse; 6. Much Worse; 7. Very Much Worse.
Quality of Life Questionnaire.
The SF-12 is a patient-rated, 12-question assessment of QOL. It is
a validated, shorter version of the commonly used SF-36. Both
scales assess important QOL domains relevant to patients suffering
from a wide range of medical conditions. The SF-12 was completed at
week 1 (Day 8), week 4 (Day 29), week 8 (Day 57), week 12 (Day 85),
week 16 (Day 113), week 20 (Day 141), and at the end-of-study (week
24 [Day 169]). QOL: A. In general, would you say your health is:
Excellent (1), Very Good (2), Good (3), Fair (4), Poor (5). B. Does
your health now limit you in these activities? If so, how much? C.
Moderate Activities, such as moving a table, pushing a vacuum
cleaner, bowling, or playing golf: Yes, Limited A Lot (1), Yes,
Limited A Little (2), No, Not Limited At All (3). 3. Climbing
several flights of stairs: Yes, Limited A Lot (1), Yes, Limited A
Little (2), No, Not Limited At All (3). D. During the past 4 weeks
have you had any of the following problems with your work or other
regular activities as a result of your physical health? 4.
Accomplished less than you would like: Yes (1), No (2). 5. Were
limited in the kind of work or other activities: Yes (1), No (2).
E. During the past 4 weeks, were you limited in the kind of work
you do or other regular activities as a result of any emotional
problems (such as feeling depressed or anxious)? 6. Accomplished
less than you would like: Yes (1), No (2). 7. Didn't do work or
other activities as carefully as usual: Yes (1), No (2). 8. During
the past 4 weeks, how much did pain interfere with your normal work
(including both work outside the home and housework)? Not At All
(1). A Little Bit (2), Moderately (3), Quite A Bit (4), Extremely
(5). F. The next three questions are about how you feel and how
things have been during the past 4 weeks. For each question, please
give the one answer that comes closest to the way you have been
feeling. How much of the time during the past 4 weeks--9. Have you
felt calm and peaceful? All of the Time (1), Most of the Time (2),
A Good Bit of the Time (3), Some of the Time (4), A Little of the
Time (5), None of the Time (6). 10. Did you have a lot of energy?
All of the Time (1), Most of the Time (2), A Good Bit of the Time
(3), Some of the Time (4), A Little of the Time (5), None of the
Time (6). 11. Have you felt downhearted and blue? All of the Time
(1), Most of the Time (2), A Good Bit of the Time (3), Some of the
Time (4), A Little of the Time (5), None of the Time (6). 12.
During the 4 weeks, how much of the time has your physical health
or emotional problems interfered with your social activities (like
visiting with friends, relatives, etc.)? All of the Time (1), Most
of the Time (2), A Good Bit of the Time (3), Some of the Time (4),
A Little of the Time (5), None of the Time (6). This questionnaire
yields an 3-scale profile of functional health and well-being
scores as well as psychometrically based physical and mental health
summary measures which are physical component summary (PCS) and
mental component summary (MCS), respectively. Change from baseline
in the standardized summary scores (MCS and PCS) to each
measurement visit was analyzed.
Neurological Evaluation.
1. Evaluation of Sensory function: A neurological evaluation of
sensory function assesses tactile sense (light touch), pain
sensation (pin prick or other) and vibration sense (tuning fork).
2. Evaluation of Motor function: A neurological evaluation of motor
function assesses muscle strength (movement of upper and lower
limbs against resistance) and reflexes (upper and lower limbs e.g.,
tricep and patellar tendons). If changes in sensation or motor
function were observed or elicited during the study, they were
monitored closely by the Investigator. If these changes became
persistent, evolved or became severe in intensity, the Investigator
referred the patient to a neurologist for a more comprehensive
diagnostic evaluation. 3. Persistence of symptoms: For the purpose
of this protocol, "persistence" of sensory or motor symptoms was
defined as "lasting for a period of 2 weeks and with no improvement
in severity." Persistence of symptoms for 2 weeks or longer
triggered an examination of the patient and a referral for
neurological consultation, if deemed appropriate. In addition, the
Investigator referred any patient at any time for a neurologic
consultation if felt to be clinically indicated. 4. Evolution of
symptoms: Evolution of symptoms in any timeframe triggered a
neurological examination. For example, if a sensory change of
"numbness" or "pins and needles" evolved into more dysesthestic or
allodynic sensations such as "burning" or "painful", it did not
matter when it occurred during the course of the study or how long
it took for the change to occur. Any patient who experienced such a
change was referred for a thorough neurological assessment whenever
a change like this was reported. In addition, as noted above, the
Investigator referred any patient for a neurologic consultation at
any time, if it was felt to be clinically indicated. Clinical
neurological assessments of sensory and motor function were
conducted at baseline (Day 1), and at week 1 (Day 8), week 2 (Day
15), week 4 (Day 29), week 8 (Day 57), week 10 (Day 71), week 12
(Day 85), week 16 (Day 113), week 20 (Day 141), and at the
end-of-study (week 24 [Day 169]).
Pharmacokinetic and Antibody Sample Collection.
Drug Concentration Measurements and Samples. Serum samples for PK
measurements were collected at every study visit beginning at
baseline (Day 1), and at week 1 (Day 8), week 2 (Day 15), week 4
(Day 29), week 8 (Day 57), week 10 (Day 71), week 12 (Day 85), week
16 (Day 113), week 20 (Day 141), and at the end of study visit
(week 24/Day 169). On study treatment days (Day 1 and week 8 [Day
57]), samples were collected prior to the start of the infusion,
immediately post infusion, and at 1, 2, and 4 hours
post-infusion.
Antibody Measurements and Samples.
Serum samples were collected for analysis of antibodies to mAb1
prior to dosing at baseline (Day 1), after administration of the
second dose (week 8 [Day 57]), at week 12 (Day 85), and at the end
of study (week 24 [Day 169]).
Use and Storage of Exploratory Serum and RNA Samples.
Exploratory samples were collected to study NGF, mAb1, pain, OA and
inflammation. Ribonucleic acid samples were collected for
exploratory microarray expression profiling. All samples were coded
to maintain patient confidentiality. Remaining RNA samples after
profiling were stored for future analyses. Serum samples were
stored and may be used for future proteomics analyses.
Analysis of Efficacy Data
Key Efficacy Endpoint: Walking Knee Pain
Mean weekly change in NRS of walking knee pain from baseline was
analyzed using a mixed-effect model repeated measure (MMRM)
approach. The MMRM analyses was implemented via PROC MIXED in SAS
by fitting changes from baseline at all post randomization visits
in the treatment period up to Week 24.
The statistical inference on the primary efficacy variable, mean
change from baseline to Week 24 in pain intensity was derived from
this model using an appropriate contrast.
The model included factors (fixed effects) for treatment,
baseline-NRS stratum (>7 and .ltoreq.7), visit,
treatment-by-visit interaction, and baseline value as a covariate.
The factor visit with nominal visits has 24 levels (e.g., Week 1 to
Week 24).
An unstructured correlation matrix was used to model the
within-patient errors. Parameters were estimated using restricted
maximum likelihood method with the Newton-Raphson algorithm.
Denominator degrees of freedom were estimated using Satterthwaite's
approximation. Least squares means (LS-means) estimates at each
week by treatment group are provided, as well as the differences of
these estimates versus placebo, with their corresponding standard
errors and associated 95% confidence intervals. Student t-tests
were used to determine the statistical significance of the
comparison of each mAb1 dose versus placebo. In addition, data and
change from baseline were summarized by treatment group using
descriptive statistics (mean, median, standard deviation, minimum
and maximum) by visits based on Observed Cases (OC). Graphical
presentations will be used to illustrate trends over time.
If the algorithm does not converge or any other computational issue
occurs, the mean weekly change in NRS of walking knee pain from
baseline was analyzed using an Analysis of Covariance (ANCOVA)
approach. The ANCOVA analyses was implemented via PROC Mixed in SAS
by fitting changes from baseline at all post randomization visits
in the treatment period up to Week 24. In the event that the mixed
model assumptions did hold, rank-based ANCOVA was performed. In the
event that the ANCOVA assumptions did not hold, rank-based ANCOVA
was performed.
The mean weekly NRS was calculated as the average of the reported
daily NRS within the week (prorated mean). If the mean weekly
change in NRS of walking knee pain from baseline for a specific
week was missing, the MMRM handled missing data by incorporating
all available data at any weekly time points for each patient into
the analysis and utilizing all existing correlations between the
weekly time points. For the ANCOVA approach, the last existing
value prior to this week was used (Last Observation Carried Forward
[LOCF] procedure).
Proportions of patients with 30% or more reduction (30% responder
rate) and 50% responder rate from baseline at each week were
summarized and plotted by the treatment group. Fisher's exact test
was applied to compare each treatment group with placebo group.
Other Efficacy Endpoints
WOMAC Index
Change from baseline in 3 subscales (pain, stiffness and function)
and the standardized total scale to each measurement visit was
analyzed similarly as for the key efficacy variable.
In the MMRM or ANCOVA model, the factor visit with nominal visits
has 9 levels (e.g., Week 1, Week 2, Week 4, Week 8, Week 10, Week
12, Week 16, Week 20 and Week 24).
Dimension scores were computed if at least 50% of items were
available within the corresponding dimension. LOCF procedure was
used for the missing data imputation for ANCOVA approach.
PGIC
PGIC at each measurement visit, as a multinomial repeated measure
with 7 categories, was analyzed as for the key efficacy variable.
The model excluded the baseline and the factor visit with nominal
visits had 7 levels (e.g., Week 1, Week 4. Week 8, Week 12, Week
16, Week 20 and Week 24). Due to the nature of non-normality,
Minimum Variance Quadratic Unbiased Estimation (MIVQUE) method was
specified in the SAS Proc Mixed to estimate the covariance
parameters.
If the algorithm did not converge or any other computational issue
occurred, an analysis of variance (ANOVA) model was applied. The
ANOVA analyses were implemented via PROC Mixed in SAS at all post
randomization visits in the treatment period up to Week 24. In the
event that the ANOVA assumptions did not hold, rank-based ANOVA was
performed.
LOCF procedure was used for the missing data imputation for the
ANOVA approach.
Quality of Life Questionnaire (SF-12)
Change from baseline in the standardized summary scores (MCS and
PCS) to each measurement visit were analyzed similarly as for the
key efficacy variable.
In MMRM or ANCOVA model, the factor visit with nominal visits had 6
levels (e.g., Week 4, Week 8, Week 12, Week 16, Week 20 and Week
24).
Total scores were computed if at least 50% of items were available.
The missing items were imputed by the mean of available items.
Dimension scores were computed if at least 50% of items were
available within the corresponding dimension.
LOCF procedure was used for the missing data imputation in the
ANCOVA approach.
Results
Key Efficacy Endpoint: Walking Knee Pain Assessed Using the
Numerical Rating Scale (NRS)
The effect of mAb1 on walking knee pain was assessed using the NRS,
as described above.
The results of this landmark analysis, which are summarized in
Table 2, indicate that mAb1 provided clinically relevant pain
relief for Walking Knee Pain compared to placebo at both the Week 8
and Week 16 evaluations. The effect at Week 24 (16 weeks after the
second dose administration) was diminished compared to the earlier
timepoints. At Week 8, the 0.1 and 0.3 mg/kg doses were
statistically significantly different from placebo at the 5%
significance level in the change from baseline. At Week 16, the two
lower doses were statistically different from placebo (0.03 and 0.1
mg/kg). None of the doses evaluated were statistically different
from placebo at the Week 24 evaluation. As this exploratory
timepoint was 16 weeks after the final dose administration, this
loss of effect was consistent with the plasma elimination half-life
of the drug
TABLE-US-00002 TABLE 2 NRS of Walking Knee Pain from Baseline to
Week 8, 16 and 24 --- Observed Data Using MMRM (Full Analysis Set)
mAb1 mAb1 mAb1 Placebo (0.03 mg/kg) (0.1 mg/kg) (0.3 mg/kg) Week (N
= 55) (N = 53) (N = 53) (N = 54) Baseline N 55 53 53 54 Mean (SD)
6.4 (1.69) 6.6 (1.65) 6.5 (1.53) 6.6 (1.47) Median 6.0 7.0 7.0 7.0
Min:Max 4:10 4:10 4:10 4:9 Week 8 Original NRS N 53 50 51 50 Mean
(SD) 4.3 (2.23) 3.9 (2.34) 3.2 (2.22) 3.1 (2.32) Median 4.3 3.8 3.7
2.4 Min:Max 0:8 0:9 0:8 0:9 Change from baseline N 53 50 51 50 Mean
(SD) -2.1 (2.08) -2.8 (2.29) -3.3 (2.61) -3.6 (2.48) Median -2.3
-2.6 -3.0 -3.9 Min:Max -6:2 -9:2 -9:1 -8:2 Difference vs. placebo
[1] LS Means (SE) -0.7 (0.43) -1.2 (0.42) -1.3 (0.43) 95% CI
-1.5:0.1 -2.0:-0.4 -2.1:-0.4 P-value 0.0981 0.0053 0.0035 Week 16
Original NRS N 45 48 45 42 Mean (SD) 3.8 (2.34) 3.2 (2.08) 3.1
(2.38) 3.2 (2.69) Median 4.1 3.2 3.0 2.9 Min:Max 0:10 0:7 0:8 0:9
Change from baseline N 45 48 45 42 Mean (SD) -2.5 (2.15) -3.4
(2.24) -3.4 (2.58) -3.3 (2.55) Median -2.3 -3.1 -3.6 -3.4 Min:Max
-7:2 -8:2 -8:2 -8:2 Difference vs. placebo [1] LS Means (SE) -1.1
(0.46) -1.0 (0.46) -0.9 (0.47) 95% CI -2.0:-0.1 -1.9:-0.1 -1.8:0.0
P-value 0.0229 0.0267 0.0631 Week 24 Original NRS N 33 39 39 35
Mean (SD) 3.7 (2.44) 4.1 (2.42) 3.2 (2.04) 3.7 (2.70) Median 4.0
4.0 3.0 4.0 Min:Max 0:8 0:9 0:8 0:8 Change from baseline N 33 39 39
35 Mean (SD) -2.4 (2.24) -2.5 (2.23) -3.3 (2.09) -2.8 (2.76) Median
-2.7 -2.2 -3.0 -3.0 Min:Max -8:2 -7:1 -8:1 -8:3 Difference vs.
placebo [1] LS Means (SE) -0.1 (0.49) -0.8 (0.49) -0.5 (0.50) 95%
CI -1.1:0.8 -1.8:0.1 -1.5:0.4 P-value 0.7736 0.0894 0.2804 Model
Effects P-Value Treatment 0.0337 Baseline 0.0015 Time <0.0001
Time-by-Treatment <0.0001 Baseline NRS Stratum 0.0120 Note: SD =
standard deviation, CI = confidence interval, SE = standard error.
[1] The difference between each mAb1 treatment group and placebo in
term of change from baseline.
Other Efficacy Endpoints
WOMAC Pain Subscale and Function Subscale
The WOMAC index was used to assess patients with OA of the hip or
knee using 24 parameters in three areas: pain (5 items), stiffness
(2 items), and function (17 items).
The results of these analyses are summarized in Table 3 (Pain
Subscale) and Table 4 (Function Subscale).
As shown in Table 3, the baseline mean WOMAC Pain Subscale scores
ranged from 5.7 to 6.4 with the mean score in the patient group
given mAb1 at 0.03 mg/kg being the smallest. Treatment effect in
terms of the LS mean difference vs. placebo in the group given 0.03
mg/kg of mAb1 was the smallest. For the groups given 0.1 mg/kg and
0.3 mg/kg of mAb1, the LS mean differences vs. placebo were similar
and ranged from -0.7 to -1.4. The p-values indicate that the
results were statistically significant at Week 8 and Week 16, but
not at Week 24.
TABLE-US-00003 TABLE 3 WOMAC Pain Subscale from Baseline to Week 8,
16 and 24 --- Observed Data Using MMRM (Full Analysis Set) mAb1
mAb1 mAb1 Placebo (0.03 mg/kg) (0.1 mg/kg) (0.3 mg/kg) Week (N =
55) (N = 53) (N = 53) (N = 54) Baseline N 55 52 53 54 Mean (SD) 5.9
(1.79) 5.7 (1.77) 6.1 (1.75) 6.4 (1.97) Median 6.2 5.5 6.2 6.8
Min:Max 1:9 2:10 2:9 3:10 Week 8 Original WOMAC pain subscale N 51
50 50 46 Mean (SD) 4.0 (1.90) 3.1 (2.05) 2.7 (2.10) 2.6 (2.33)
Median 4.0 2.8 2.3 2.1 Min:Max 0:8 0:9 0:7 0:7 Change from baseline
N 51 49 50 46 Mean (SD) -1.9 (1.74) -2.6 (2.01) -3.4 (2.54) -3.5
(2.42) Median -1.4 -2.6 -3.1 -3.3 Min:Max -7:2 -7:3 -8:1 -9:3
Difference vs. placebo [1] LS Means (SE) -0.9 (0.39) -1.4 (0.39)
-1.3 (0.39) 95% CI -1.7:-0.1 -2.2:-0.7 -2.1:-0.5 P-value 0.0228
0.0003 0.0010 Week 16 Original WOMAC pain subscale N 44 47 44 41
Mean (SD) 3.5 (2.31) 2.9 (2.15) 2.6 (2.15) 2.8 (2.38) Median 3.6
2.4 2.3 2.4 Min:Max 0:10 0:10 0:8 0:8 Change from baseline N 44 47
44 41 Mean (SD) -2.4 (2.18) -2.7 (1.89) -3.4 (2.53) -3.2 (2.24)
Median -1.9 -2.4 -3.4 -3.4 Min:Max -8:1 -7:1 -8:2 -9:2 Difference
vs. placebo [1] LS Means (SE) -0.6 (0.42) -1.1 (0.42) -0.8 (0.42)
95% CI -1.4:0.2 -1.9:-0.3 -1.7:-0.0 P-value 0.1486 0.0090 0.0488
Week 24 Original WOMAC pain subscale N 38 46 42 37 Mean (SD) 3.4
(2.15) 3.6 (2.30) 3.1 (2.31) 3.1 (2.47) Median 3.4 3.3 2.7 2.4
Min:Max 0:8 0:8 0:9 0:8 Change from baseline N 38 46 42 37 Mean
(SD) -2.4 (2.19) -2.0 (2.15) -2.9 (2.46) -2.8 (2.26) Median -2.0
-1.8 -2.5 -3.0 Min:Max -8:1 -7:2 -8:3 -9:2 Difference vs. placebo
[1] LS Means (SE) -0.1 (0.45) -0.7 (0.46) -0.7 (0.47) 95% CI
-1.0:0.8 -1.6:0.2 -1.6:0.3 P-value 0.8648 0.1513 0.1601 Note: SD =
standard deviation, CI = confidence interval, SE = standard error.
[1] The difference between each mAb1 treatment group and placebo in
term of change from baseline.
As shown in Table 4, the baseline mean WOMAC Function Subscale
scores were similar and ranged from 5.9 to 62. Treatment effect in
terms of the LS mean differences vs. placebo for mAb1 0.03 mg/kg
group was the smallest. For the two groups of patients given mAb1
at 0.1 mg/kg and 0.3 mg/kg, the treatment effects were similar and
ranged from -0.6 to -1.6. The p-values were statistically
significant for the week 8 duration and the week 16 duration,
respectively, but not for the week 24 duration. For the group of
patients given mAb1 at 0.03 mg/kg, the p-value was statistically
significant for the week 8 duration and had a marginal value for
the week 16 duration (p=0.0693), but was not significant for the
week 24 duration.
TABLE-US-00004 TABLE 4 WOMAC Function Subscale from Baseline to
Week 8, 16 and 24 --- Observed Data Using MMRM (Full Analysis Set)
mAb1 mAb1 mAb1 Placebo (0.03 mg/kg) (0.1 mg/kg) (0.3 mg/kg) Week (N
= 55) (N = 53) (N = 53) (N = 54) Baseline N 55 52 53 54 Mean (SD)
5.9 (1.75) 5.9 (1.83) 6.2 (1.67) 6.2 (2.07) Median 6.2 5.9 6.2 6.6
Min:Max 2:9 2:10 3:9 1:10 Week 8 Original WOMAC function subscale N
51 50 50 46 Mean (SD) 4.1 (2.08) 3.1 (2.09) 2.8 (2.14) 2.6 (2.44)
Median 4.5 2.6 2.4 1.5 Min:Max 0:8 0:10 0:7 0:8 Change from
baseline N 51 49 50 46 Mean (SD) -1.8 (1.95) -2.8 (2.07) -3.4
(2.32) -3.4 (2.57) Median -1.4 -3.1 -3.2 -3.5 Min:Max -7:2 -7:2
-9:1 -9:5 Difference vs. placebo [1] LS Means (SE) -1.2 (0.41) -1.6
(0.40) -1.4 (0.40) 95% CI -2.0:-0.4 -2.4:-0.8 -2.2:-0.6 P-value
0.0037 0.0001 0.0005 Week 16 Original WOMAC function subscale N 44
47 44 41 Mean (SD) 3.6 (2.26) 3.0 (2.21) 2.7 (2.26) 2.7 (2.43)
Median 3.2 2.9 2.5 1.5 Min:Max 0:9 0:9 0:8 0:8 Change from baseline
N 44 47 44 41 Mean (SD) -2.3 (2.30) -2.9 (1.78) -3.4 (2.28) -3.1
(2.18) Median -1.5 -2.9 -3.5 -3.3 Min:Max -8:1 -7:1 -9:1 -9:4
Difference vs. placebo [1] LS Means (SE) -0.8 (0.41) -1.1 (0.41)
-0.9 (0.42) 95% CI -1.6:0.1 -1.9:-0.3 -1.8:-0.1 P-value 0.0693
0.0071 0.0245 Week 24 Original WOMAC function subscale N 38 46 42
37 Mean (SD) 3.4 (2.15) 3.6 (2.35) 3.2 (2.33) 3.0 (2.43) Median 3.4
3.3 2.7 2.7 Min:Max 0:8 0:8 0:9 0:7 Change from baseline N 38 46 42
37 Mean (SD) -2.4 (2.29) -2.3 (2.05) -2.9 (2.30) -2.6 (2.40) Median
-2.0 -2.3 -2.6 -3.0 Min:Max -8:1 -7:3 -9:2 -9:4 Difference vs.
placebo [1] LS Means (SE) -0.3 (0.45) -0.7 (0.45) -0.6 (0.46) 95%
CI -1.2:0.6 -1.5:0.2 -1.5:0.3 P-value 0.5214 0.1499 0.1748 Note: SD
= standard deviation, CI = confidence interval, SE = standard
error. [1] The difference between each mAb1 treatment group and
placebo in term of change from baseline.
PGIC
The results of the patient-rated assessment of response to
treatment (PGIC) are shown in Table 5.
TABLE-US-00005 TABLE 5 Patients Global Impression of Change (PGIC)
at Week 8, 16 and 24 --- Observed Data Using MMRM (Full Analysis
Set) mAb1 mAb1 mAb1 Placebo (0.03 mg/kg) (0.1 mg/kg) (0.3 mg/kg)
Week (N = 55) (N = 53) (N = 53) (N = 54) Week 8 PGIC N 51 50 50 46
Mean (SD) 3.1 (1.21) 2.3 (1.00) 2.1 (1.10) 2.1 (0.98) Median 3.0
2.0 2.0 2.0 Min:Max 1:6 1:4 1:5 1:4 Difference vs. placebo [1] LS
Means (SE) -0.8 (0.21) -1.0 (0.21) -0.9 (0.21) 95% CI -1.2:-0.4
-1.4:-0.6 -1.4:-0.5 P-value 0.0002 <0.0001 <0.0001 Week 16
PGIC N 44 47 43 41 Mean (SD) 2.8 (1.32) 2.2 (0.95) 2.5 (1.26) 2.4
(1.16) Median 3.0 2.0 2.0 2.0 Min:Max 1:7 1:5 1:6 1:5 Difference
vs. placebo [1] LS Means (SE) -0.7 (0.24) -0.4 (0.24) -0.5 (0.25)
95% CI -1.1:-0.2 -0.9:0.1 -1.0:-0.1 P-value 0.0056 0.1168 0.0297
Week 24 PGIC N 38 46 42 37 Mean (SD) 2.7 (0.94) 2.8 (1.41) 2.7
(1.40) 2.5 (1.07) Median 3.0 3.0 2.0 2.0 Min:Max 1:5 1:6 1:6 1:6
Difference vs. placebo [1] LS Means (SE) -0.1 (0.26) -0.1 (0.27)
-0.3 (0.28) 95% CI -0.6:0.5 -0.6:0.5 -0.8:0.2 P-value 0.8274 0.8091
0.2710 Note: SD = standard deviation, CI = confidence interval, SE
= standard error. [1] The difference between each mAb1 treatment
group and placebo in term of change from baseline.
For all 3 mAb1 treatment groups at week 8, the LS means difference
vs. placebo ranged from -1.0 to -0.8 and were statistically
significant at the 5% level. Results of the patient groups given
mAb1 at 0.03 mg/kg and 0.3 mg/kg as compared with placebo were
statistically significant at week 16. None of the three mAb1 groups
was significantly different from placebo at week 24.
Quality of Life Questionnaire (SF-12)
The results of the analyses from the Quality of Life questionnaire
are shown in Table 6 (Physical Component Score) and Table 7 (Mental
Component Score).
TABLE-US-00006 TABLE 6 SF-12 Physical Component Score (PCS) from
Baseline to Week 8, 16 and 24 --- Observed Data Using MMRM (Full
Analysis Set) mAb1 mAb1 mAb1 Placebo (0.03 mg/kg) (0.1 mg/kg) (0.3
mg/kg) Week (N = 55) (N = 53) (N = 53) (N = 54) Baseline N 54 52 53
53 Mean (SD) 34.0 (8.06) 32.0 (8.97) 32.3 (9.65) 33.6 (8.82) Median
31.9 32.6 30.7 33.2 Min:Max 19:53 14:57 9:55 16:53 Week 8 Original
PCS N 51 50 49 46 Mean (SD) 37.4 (8.98) 40.5 (9.24) 41.5 (8.46)
42.9 (8.43) Median 35.6 41.1 42.6 43.4 Min:Max 16:58 22:60 22:56
22:56 Change from baseline N 50 49 49 45 Mean (SD) 2.9 (6.64) 8.3
(8.18) 9.0 (9.42) 8.4 (9.29) Median 2.1 6.6 9.3 7.3 Min:Max -10:19
-7:23 -9:40 -12:36 Difference vs. placebo [1] LS Means (SE) 4.4
(1.47) 5.1 (1.46) 5.6 (1.49) 95% CI 1.5:7.3 2.2:8.0 2.6:8.5 P-value
0.0034 0.0006 0.0002 Week 16 Original PCS N 44 46 43 41 Mean (SD)
40.3 (8.82) 41.7 (9.72) 41.0 (9.31) 43.2 (9.57) Median 39.5 40.3
40.5 42.2 Min:Max 24:59 22:62 21:63 26:61 Change from baseline N 43
46 43 40 Mean (SD) 6.1 (8.43) 9.7 (8.78) 8.4 (10.57) 9.2 (10.74)
Median 5.7 8.3 8.1 8.0 Min:Max -11:23 -6:30 -8:42 -8:38 Difference
vs. placebo [1] LS Means (SE) 3.0 (1.72) 1.9 (1.73) 3.6 (1.76) 95%
CI -0.4:6.4 -1.5:5.3 0.1:7.1 P-value 0.0854 0.2647 0.0415 Week 24
Original PCS N 38 46 42 37 Mean (SD) 40.3 (9.89) 39.2 (10.39) 40.2
(9.72) 38.9 (9.45) Median 40.7 39.8 41.5 38.2 Min:Max 23:58 18:61
16:61 24:62 Change from baseline N 37 46 42 36 Mean (SD) 6.6 (9.02)
7.3 (10.09) 7.2 (9.54) 4.8 (10.52) Median 5.9 6.5 4.7 3.6 Min:Max
-11:25 -10:36 -11:35 -17:43 Difference vs. placebo [1] LS Means
(SE) 1.2 (1.86) 1.1 (1.89) -0.6 (1.95) 95% CI -2.5:4.8 -2.6:4.9
-4.4:3.3 P-value 0.5340 0.5444 0.7759 Note: SD = standard
deviation, CI = confidence interval, SE = standard error. [1] The
difference between each mAb1 treatment group and placebo in term of
change from baseline.
The baseline means SF-12 PCS were similar among the four groups.
The LS mean vs. placebo at week 4 on PCS for the patient groups
given mAb1 at 0.03 mg/kg. 0.1 mg/kg, and 0.3 mg/kg were 4.4, 5.1,
and 5.6, respectively, with p-values of 0.0034, 0.0006, and 0.0002,
respectively. The p-value was significant for the group given mAb1
at 0.3 mg/kg at week 16, but not for the other two groups. All
p-values were non-significant at week 24.
TABLE-US-00007 TABLE 7 SF-12 Mental Component Score (MCS) from
Baseline to Week 8, 16 and 24 --- Observed Data Using MMRM (Full
Analysis Set) mAb1 mAb1 mAb1 Placebo (0.03 mg/kg) (0.1 mg/kg) (0.3
mg/kg) Week (N = 55) (N = 53) (N = 53) (N = 54) Baseline N 54 52 53
53 Mean (SD) 51.7 (11.89) 51.8 (11.73) 51.4 (10.96) 51.3 (11.63)
Median 51.8 54.7 53.2 51.6 Min:Max 17:71 27:69 25:68 24:71 Week 8
Original MCS N 51 50 49 46 Mean (SD) 54.2 (9.43) 54.2 (9.01) 54.0
(8.55) 53.7 (10.18) Median 56.6 55.4 56.5 55.1 Min:Max 30:69 33:70
31:67 25:69 Change from baseline N 50 49 49 45 Mean (SD) 2.7 (9.70)
1.9 (9.49) 3.2 (9.06) 1.8 (9.61) Median 0.9 0.9 1.6 1.1 Min:Max
-19:33 -19:21 -11:37 -20:25 Difference vs. placebo [1] LS Means
(SE) -0.3 (1.50) 0.3 (1.49) -0.7 (1.53) 95% CI -3.3:2.6 -2.7:3.2
-3.7:2.3 P-value 0.8169 0.8557 0.6597 Week 16 Original MCS N 44 46
43 41 Mean (SD) 55.4 (8.16) 52.5 (9.79) 53.0 (9.17) 52.2 (10.00)
Median 57.4 54.7 54.2 53.7 Min:Max 34:67 25:68 22:67 27:71 Change
from baseline N 43 46 43 40 Mean (SD) 3.5 (11.28) -0.4 (10.26) 2.5
(7.66) 0.2 (8.91) Median 1.3 -0.2 1.4 -0.2 Min:Max -19:33 -38:28
-12:16 -13:17 Difference vs. placebo [1] LS Means (SE) -3.1 (1.57)
-1.8 (1.58) -2.9 (1.61) 95% CI -6.2:-0.0 -4.9:1.3 -6.1:0.3 P-value
0.0488 0.2624 0.0749 Week 24 Original MCS N 38 46 42 37 Mean (SD)
53.5 (10.09) 50.9 (9.97) 54.9 (9.60) 54.8 (9.07) Median 55.1 53.6
55.3 57.5 Min:Max 16:68 21:70 35:72 33:70 Change from baseline N 37
46 42 36 Mean (SD) 1.4 (9.43) -1.4 (10.35) 4.5 (8.04) 2.7 (10.69)
Median 0.0 -3.1 3.8 0.7 Min:Max -16:31 -27:23 -16:25 -14:26
Difference vs. placebo [1] LS Means (SE) -2.9 (1.66) 1.8 (1.68) 1.1
(1.74) 95% CI -6.2:0.3 -1.5:5.1 -2.3:4.5 P-value 0.0775 0.2912
0.5316 Note: SD = standard deviation, CI = confidence interval, SE
= standard error. [1] The difference between each mAb1 treatment
group and placebo in term of change from baseline.
The baseline mean SF-12 Mental Component Score (MCS) was similar
among the four groups. The p-values indicate non-significant
results at all time points for all groups except for the group
given mAb1 at 0.3 mg/kg at week 16 (p=0.0415).
Summary
The results of the key efficacy analysis showed that the 2 higher
mAb1 doses (0.1 mg/kg and 0.3 mg/kg) consistently demonstrated
significant treatment effects as compared with placebo up to week
16 on most efficacy endpoints.
SEQUENCE LISTINGS
1
591847DNAHomo sapiens 1agcgtccgga cccaataaca gttttaccaa gggagcagct
ttctatcctg gccacactga 60ggtgcatagc gtaatgtcca tgttgttcta cactctgatc
acagcttttc tgatcggcat 120acaggcggaa ccacactcag agagcaatgt
ccctgcagga cacaccatcc cccaagccca 180ctggactaaa cttcagcatt
cccttgacac tgcccttcgc agagcccgca gcgccccggc 240agcggcgata
gctgcacgcg tggcggggca gacccgcaac attactgtgg accccaggct
300gtttaaaaag cggcgactcc gttcaccccg tgtgctgttt agcacccagc
ctccccgtga 360agctgcagac actcaggatc tggacttcga ggtcggtggt
gctgccccct tcaacaggac 420tcacaggagc aagcggtcat catcccatcc
catcttccac aggggcgaat tctcggtgtg 480tgacagtgtc agcgtgtggg
ttggggataa gaccaccgcc acagacatca agggcaagga 540ggtgatggtg
ttgggagagg tgagcattaa caacagtgta ttcaaacagt acttttttga
600gaccaagtgc cgggacccaa atcccgttga cagcgggtgc cggggcattg
actcaaagca 660ctggaactca tattgtacca cgactcacac ctttgtcaag
gcgctgacca tggatggcaa 720gcaggctgcc tggcggttta tccggataga
tacggcctgt atgtgtgtgc tcagcaggaa 780ggctgtgaga agagcctgac
ctgccgacac gctccctccc cctgcccctt ctacactctc 840ctgggcc
8472115PRTHomo sapiens 2Ser Ser Ser His Pro Ile Phe His Arg Gly Glu
Phe Ser Val Val Ser 1 5 10 15 Val Trp Val Gly Asp Lys Thr Thr Ala
Thr Asp Ile Lys Gly Lys Glu 20 25 30 Val Met Val Leu Gly Glu Val
Asn Ile Asn Asn Ser Val Phe Lys Gln 35 40 45 Tyr Phe Phe Glu Thr
Lys Cys Arg Asp Pro Asn Pro Val Asp Ser Gly 50 55 60 Cys Arg Gly
Ile Asp Ser Lys His Trp Asn Ser Tyr Cys Thr Thr Thr65 70 75 80 His
Thr Phe Ala Leu Thr Met Asp Gly Lys Gln Ala Ala Trp Arg Phe 85 90
95 Ile Arg Ile Asp Thr Ala Cys Val Cys Val Leu Ser Arg Lys Ala Val
100 105 110 Arg Arg Ala 115 3357DNAArtificial SequenceSynthetic
3caggtgcagc tggtacagtc tggggctgag gtgaagaagc ctggggcctc agtgaaggtc
60tcctgcaagg tttccggatt caccctcact gaattatcca ttcactgggt gcgacaggct
120cctggaaaag ggcttgagtg gatgggaggt tttgatcctg aagatggtga
aacaatctac 180gcacagaagt tccagggcag agtcaccatg accgaggaca
catctacaga cacagcctac 240atggagctga ccagcctgag atcggaagac
acggccgtgt attactgttc aacgattttt 300ggagtggtta ccaactttga
caactggggc cagggaaccc tggtcaccgt ctcctca 3574119PRTArtificial
SequenceSynthetic 4Gln Val Gln Leu Val Gln Ser Gly Ala Glu Val Lys
Lys Pro Gly Ala 1 5 10 15 Ser Val Lys Val Ser Cys Lys Val Ser Gly
Phe Thr Leu Thr Glu Leu 20 25 30 Ser Ile His Trp Val Arg Gln Ala
Pro Gly Lys Gly Leu Glu Trp Met 35 40 45 Gly Gly Phe Asp Pro Glu
Asp Gly Glu Thr Ile Tyr Ala Gln Lys Phe 50 55 60 Gln Gly Arg Val
Thr Met Thr Glu Asp Thr Ser Thr Asp Thr Ala Tyr65 70 75 80 Met Glu
Leu Thr Ser Leu Arg Ser Glu Asp Thr Ala Val Tyr Tyr Cys 85 90 95
Ser Thr Ile Phe Gly Val Val Thr Asn Phe Asp Asn Trp Gly Gln Gly 100
105 110 Thr Leu Val Thr Val Ser Ser 115 524DNAArtificial
SequenceSynthetic 5ggattcaccc tcactgaatt atcc 2468PRTArtificial
SequenceSynthetic 6Gly Phe Thr Leu Thr Glu Leu Ser 1 5
724DNAArtificial SequenceSynthetic 7tttgatcctg aagatggtga aaca
2488PRTArtificial SequenceSynthetic 8Phe Asp Pro Glu Asp Gly Glu
Thr 1 5 936DNAArtificial SequenceSynthetic 9tcaacgattt ttggagtggt
taccaacttt gacaac 361012PRTArtificial SequenceSynthetic 10Ser Thr
Ile Phe Gly Val Val Thr Asn Phe Asp Asn 1 5 10 11324DNAArtificial
SequenceSynthetic 11gacatccgga tgacccagtc tccatcctcc ctgtctgcat
ctgcaggaga cagagtcacc 60atcacttgcc gggcaagtca ggccattaga aatgatttag
gctggtatca gcagaaacca 120gggaaagccc ctaagcgcct gatctatgct
gcattcaatt tgcaaagtgg ggtcccatca 180agattcagcg gcagtggatc
tgggacagaa ttcactctca caatcagtag cctgcagcct 240gaagatcttg
caagttatta ctgtcaacag tataatagat acccgtggac gttcggccaa
300gggaccaagc tggagatcaa acga 32412107PRTArtificial
SequenceSynthetic 12Asp Ile Arg Met Thr Gln Ser Pro Ser Ser Leu Ser
Ala Ser Ala Gly 1 5 10 15 Asp Arg Val Thr Ile Thr Cys Arg Ala Ser
Gln Ala Ile Arg Asn Asp 20 25 30 Leu Gly Trp Tyr Gln Gln Lys Pro
Gly Lys Ala Pro Lys Arg Leu Ile 35 40 45 Tyr Ala Ala Phe Asn Leu
Gln Ser Gly Val Pro Ser Arg Phe Ser Gly 50 55 60 Ser Gly Ser Gly
Thr Glu Phe Thr Leu Thr Ile Ser Ser Leu Gln Pro65 70 75 80 Glu Asp
Leu Ala Ser Tyr Tyr Cys Gln Gln Tyr Asn Arg Tyr Pro Trp 85 90 95
Thr Phe Gly Gln Gly Thr Lys Leu Glu Ile Lys 100 105
1318DNAArtificial SequenceSynthetic 13caggccatta gaaatgat
18146PRTArtificial SequenceSynthetic 14Gln Ala Ile Arg Asn Asp 1 5
159DNAArtificial SequenceSynthetic 15gctgcattc 9163PRTArtificial
SequenceSynthetic 16Ala Ala Phe 1 1727DNAArtificial
SequenceSynthetic 17caacagtata atagataccc gtggacg
27189PRTArtificial SequenceSynthetic 18Gln Gln Tyr Asn Arg Tyr Pro
Trp Thr 1 5 19357DNAArtificial SequenceSynthetic 19caggtgcagc
tggtgcagtc cggcgccgag gtgaagaagc ccggcgcctc cgtgaaggtg 60tcctgcaagg
tgtccggctt caccctgacc gagctgtcca tgcactgggt gcggcaggcc
120cccggcaagg gcctggagtg gatgggcggc ttcgaccccg aggacggcga
gaccatctac 180gcccagaagt tccagggccg ggtgaccatg accgaggaca
cctccaccga caccgcctac 240atggagctgt cctccctgcg gtccgaggac
accgccgtgt actactgctc caccatcttc 300ggcgtggtga ccaacttcga
caactggggc cagggcaccc tggtgaccgt gtcctcc 35720119PRTArtificial
SequenceSynthetic 20Gln Val Gln Leu Val Gln Ser Gly Ala Glu Val Lys
Lys Pro Gly Ala 1 5 10 15 Ser Val Lys Val Ser Cys Lys Val Ser Gly
Phe Thr Leu Thr Glu Leu 20 25 30 Ser Met His Trp Val Arg Gln Ala
Pro Gly Lys Gly Leu Glu Trp Met 35 40 45 Gly Gly Phe Asp Pro Glu
Asp Gly Glu Thr Ile Tyr Ala Gln Lys Phe 50 55 60 Gln Gly Arg Val
Thr Met Thr Glu Asp Thr Ser Thr Asp Thr Ala Tyr65 70 75 80 Met Glu
Leu Ser Ser Leu Arg Ser Glu Asp Thr Ala Val Tyr Tyr Cys 85 90 95
Ser Thr Ile Phe Gly Val Val Thr Asn Phe Asp Asn Trp Gly Gln Gly 100
105 110 Thr Leu Val Thr Val Ser Ser 115 21324DNAArtificial
SequenceSynthetic 21gacatccaga tgacccagtc cccctcctcc ctgtccgcct
ccgtgggcga ccgggtgacc 60atcacctgcc gggcctccca ggccatccgg aacgacctgg
gctggtacca gcagaagccc 120ggcaaggccc ccaagcggct gatctacgcc
gccttcaacc tgcagtccgg cgtgccctcc 180cggttctccg gctccggctc
cggcaccgag ttcaccctga ccatctcctc cctgcagccc 240gaggacttcg
ccacctacta ctgccagcag tacaaccggt acccctggac cttcggccag
300ggcaccaagg tggagatcaa gcgg 32422108PRTArtificial
SequenceSynthetic 22Asp Ile Gln Met Thr Gln Ser Pro Ser Ser Leu Ser
Ala Ser Val Gly 1 5 10 15 Asp Arg Val Thr Ile Thr Cys Arg Ala Ser
Gln Ala Ile Arg Asn Asp 20 25 30 Leu Gly Trp Tyr Gln Gln Lys Pro
Gly Lys Ala Pro Lys Arg Leu Ile 35 40 45 Tyr Ala Ala Phe Asn Leu
Gln Ser Gly Val Pro Ser Arg Phe Ser Gly 50 55 60 Ser Gly Ser Gly
Thr Glu Phe Thr Leu Thr Ile Ser Ser Leu Gln Pro65 70 75 80 Glu Asp
Phe Ala Thr Tyr Tyr Cys Gln Gln Tyr Asn Arg Tyr Pro Trp 85 90 95
Thr Phe Gly Gln Gly Thr Lys Val Glu Ile Lys Arg 100 105
23357DNAArtificial SequenceSynthetic 23caggtgcagc tggtgcagtc
tggggctgag gtgaagaagc ctggggcctc agtgaaggtc 60tcctgcaagg tttccggatt
caccctcact gaattatcca ttcactgggt gcgacaggct 120cctggaaaag
ggcttgagtg gatgggaggt tttgatcctg aagatggtga aacaatctac
180gcacagaagt tccagggcag agtcaccatg accgaggaca catctacaga
cacagcctac 240atggagctga ccagcctgag atcggaagac acggccgtgt
attactgttc aacgattttt 300ggagtggtta ccaactttga caactggggc
cagggaaccc tggtcaccgt ctcctca 35724119PRTArtificial
SequenceSynthetic 24Gln Val Gln Leu Val Gln Ser Gly Ala Glu Val Lys
Lys Pro Gly Ala 1 5 10 15 Ser Val Lys Val Ser Cys Lys Val Ser Gly
Phe Thr Leu Thr Glu Leu 20 25 30 Ser Ile His Trp Val Arg Gln Ala
Pro Gly Lys Gly Leu Glu Trp Met 35 40 45 Gly Gly Phe Asp Pro Glu
Asp Gly Glu Thr Ile Tyr Ala Gln Lys Phe 50 55 60 Gln Gly Arg Val
Thr Met Thr Glu Asp Thr Ser Thr Asp Thr Ala Tyr65 70 75 80 Met Glu
Leu Thr Ser Leu Arg Ser Glu Asp Thr Ala Val Tyr Tyr Cys 85 90 95
Ser Thr Ile Phe Gly Val Val Thr Asn Phe Asp Asn Trp Gly Gln Gly 100
105 110 Thr Leu Val Thr Val Ser Ser 115 25324DNAArtificial
SequenceSynthetic 25gacatccaga tgacccagtc tccatcctcc ctgtctgcat
ctgcaggaga cagagtcacc 60atcacttgcc gggcaagtca ggccattaga aatgatttag
gctggtatca gcagaaacca 120gggaaagccc ctaagcgcct gatctatgct
gcattcaatt tgcaaagtgg ggtcccatca 180agattcagcg gcagtggatc
tgggacagaa ttcactctca caatcagtag cctgcagcct 240gaagatcttg
caagttatta ctgtcaacag tataatagat acccgtggac gttcggccaa
300gggaccaagg tggaaatcaa acga 32426108PRTArtificial
SequenceSynthetic 26Asp Ile Gln Met Thr Gln Ser Pro Ser Ser Leu Ser
Ala Ser Ala Gly 1 5 10 15 Asp Arg Val Thr Ile Thr Cys Arg Ala Ser
Gln Ala Ile Arg Asn Asp 20 25 30 Leu Gly Trp Tyr Gln Gln Lys Pro
Gly Lys Ala Pro Lys Arg Leu Ile 35 40 45 Tyr Ala Ala Phe Asn Leu
Gln Ser Gly Val Pro Ser Arg Phe Ser Gly 50 55 60 Ser Gly Ser Gly
Thr Glu Phe Thr Leu Thr Ile Ser Ser Leu Gln Pro65 70 75 80 Glu Asp
Leu Ala Ser Tyr Tyr Cys Gln Gln Tyr Asn Arg Tyr Pro Trp 85 90 95
Thr Phe Gly Gln Gly Thr Lys Val Glu Ile Lys Arg 100 105
27375DNAArtificial SequenceSynthetic 27gaagtgcagc tggtgcagtc
tgggggcggc ttggtacagc ctggcaggtc cctgagactc 60tcctgtgcag cccctggatt
caactttgat gattatgcca tgcactgggt ccggcaaact 120ccagggaagg
gcctggagtg ggtctcaggt attagttgga atagtggtac tataggctat
180gcggactctg tgaagggccg atttaccatc tccagagaca acgccaagaa
ctccctgtat 240cttcaaatga acagtctgag acctgaggac acggccttgt
attactgtgc aaaagaaggg 300gtatggttcg gaaaattgtt ctcatcctac
ggtatggacg tctggggcca agggaccacg 360gtcaccgtct cctca
37528125PRTArtificial SequenceSynthetic 28Glu Val Gln Leu Val Gln
Ser Gly Gly Gly Leu Val Gln Pro Gly Arg 1 5 10 15 Ser Leu Arg Leu
Ser Cys Ala Ala Pro Gly Phe Asn Phe Asp Asp Tyr 20 25 30 Ala Met
His Trp Val Arg Gln Thr Pro Gly Lys Gly Leu Glu Trp Val 35 40 45
Ser Gly Ile Ser Trp Asn Ser Gly Thr Ile Gly Tyr Ala Asp Ser Val 50
55 60 Lys Gly Arg Phe Thr Ile Ser Arg Asp Asn Ala Lys Asn Ser Leu
Tyr65 70 75 80 Leu Gln Met Asn Ser Leu Arg Pro Glu Asp Thr Ala Leu
Tyr Tyr Cys 85 90 95 Ala Lys Glu Gly Val Trp Phe Gly Lys Leu Phe
Ser Ser Tyr Gly Met 100 105 110 Asp Val Trp Gly Gln Gly Thr Thr Val
Thr Val Ser Ser 115 120 125 2924DNAArtificial SequenceSynthetic
29ggattcaact ttgatgatta tgcc 24308PRTArtificial SequenceSynthetic
30Gly Phe Asn Phe Asp Asp Tyr Ala 1 5 3124DNAArtificial
SequenceSynthetic 31attagttgga atagtggtac tata 24328PRTArtificial
SequenceSynthetic 32Ile Ser Trp Asn Ser Gly Thr Ile 1 5
3354DNAArtificial SequenceSynthetic 33gcaaaagaag gggtatggtt
cggaaaattg ttctcatcct acggtatgga cgtc 543418PRTArtificial
SequenceSynthetic 34Ala Lys Glu Gly Val Trp Phe Gly Lys Leu Phe Ser
Ser Tyr Gly Met 1 5 10 15 Asp Val35321DNAArtificial
SequenceSynthetic 35gacatccgga tgacccagtc tccagccacc ctgtctgtgt
ctccagggga aagagccacc 60ctctcctgca gggccagtca gagtgttact tacaacttag
actggtacca gcagaaacct 120ggccaggctc ccaggctcct catctttggt
gcatccacca gggccactgg tatcccagcc 180aggttcagtg gcagtgggtc
tgggacagag ttcactctca ccatcaccag cctgcagtct 240gaagattttg
cagtttatta ctgtcagcag tataataact ggccgtacac ttttggccag
300gggaccaagg tggaaatcaa a 32136107PRTArtificial SequenceSynthetic
36Asp Ile Arg Met Thr Gln Ser Pro Ala Thr Leu Ser Val Ser Pro Gly 1
5 10 15 Glu Arg Ala Thr Leu Ser Cys Arg Ala Ser Gln Ser Val Thr Tyr
Asn 20 25 30 Leu Asp Trp Tyr Gln Gln Lys Pro Gly Gln Ala Pro Arg
Leu Leu Ile 35 40 45 Phe Gly Ala Ser Thr Arg Ala Thr Gly Ile Pro
Ala Arg Phe Ser Gly 50 55 60 Ser Gly Ser Gly Thr Glu Phe Thr Leu
Thr Ile Thr Ser Leu Gln Ser65 70 75 80 Glu Asp Phe Ala Val Tyr Tyr
Cys Gln Gln Tyr Asn Asn Trp Pro Tyr 85 90 95 Thr Phe Gly Gln Gly
Thr Lys Val Glu Ile Lys 100 105 3718DNAArtificial SequenceSynthetic
37cagagtgtta cttacaac 18386PRTArtificial SequenceSynthetic 38Gln
Ser Val Thr Tyr Asn 1 5 399DNAArtificial SequenceSynthetic
39ggtgcatcc 9403PRTArtificial SequenceSynthetic 40Gly Ala Ser 1
4127DNAArtificial SequenceSynthetic 41cagcagtata ataactggcc gtacact
27429PRTArtificial SequenceSynthetic 42Gln Gln Tyr Asn Asn Trp Pro
Tyr Thr 1 5 43375DNAArtificial SequenceSynthetic 43gaggtgcagc
tggtggagtc cggcggcggc ctggtgcagc ccggccggtc cctgcggctg 60tcctgcgccg
cccccggctt caacttcgac gactacgcca tgcactgggt gcggcaggcc
120cccggcaagg gcctggagtg ggtgtccggc atctcctgga actccggcac
catcggctac 180gccgactccg tgaagggccg gttcaccatc tcccgggaca
acgccaagaa ctccctgtac 240ctgcagatga actccctgcg ggccgaggac
accgccctgt actactgcgc caaggagggc 300gtgtggttcg gcaagctgtt
ctcctcctac ggcatggacg tgtggggcca gggcaccacc 360gtgaccgtgt cctcc
37544125PRTArtificial SequenceSynthetic 44Glu Val Gln Leu Val Glu
Ser Gly Gly Gly Leu Val Gln Pro Gly Arg 1 5 10 15 Ser Leu Arg Leu
Ser Cys Ala Ala Pro Gly Phe Asn Phe Asp Asp Tyr 20 25 30 Ala Met
His Trp Val Arg Gln Ala Pro Gly Lys Gly Leu Glu Trp Val 35 40 45
Ser Gly Ile Ser Trp Asn Ser Gly Thr Ile Gly Tyr Ala Asp Ser Val 50
55 60 Lys Gly Arg Phe Thr Ile Ser Arg Asp Asn Ala Lys Asn Ser Leu
Tyr65 70 75 80 Leu Gln Met Asn Ser Leu Arg Ala Glu Asp Thr Ala Leu
Tyr Tyr Cys 85 90 95 Ala Lys Glu Gly Val Trp Phe Gly Lys Leu Phe
Ser Ser Tyr Gly Met 100 105 110 Asp Val Trp Gly Gln Gly Thr Thr Val
Thr Val Ser Ser 115 120 125 45324DNAArtificial SequenceSynthetic
45gagatcgtga tgacccagtc ccccgccacc ctgtccgtgt cccccggcga gcgggccacc
60ctgtcctgcc gggcctccca gtccgtgacc tacaacctgg actggtacca gcagaagccc
120ggccaggccc cccggctgct gatctacggc gcctccaccc gggccaccgg
catccccgcc 180cggttctccg gctccggctc cggcaccgag ttcaccctga
ccatctcctc cctgcagtcc 240gaggacttcg ccgtgtacta ctgccagcag
tacaacaact ggccctacac cttcggccag 300ggcaccaagc tggagatcaa gcgg
32446108PRTArtificial SequenceSynthetic 46Glu Ile Val Met Thr Gln
Ser Pro
Ala Thr Leu Ser Val Ser Pro Gly1 5 10 15 Glu Arg Ala Thr Leu Ser
Cys Arg Ala Ser Gln Ser Val Thr Tyr Asn 20 25 30 Leu Asp Trp Tyr
Gln Gln Lys Pro Gly Gln Ala Pro Arg Leu Leu Ile 35 40 45 Tyr Gly
Ala Ser Thr Arg Ala Thr Gly Ile Pro Ala Arg Phe Ser Gly 50 55 60
Ser Gly Ser Gly Thr Glu Phe Thr Leu Thr Ile Ser Ser Leu Gln Ser65
70 75 80 Glu Asp Phe Ala Val Tyr Tyr Cys Gln Gln Tyr Asn Asn Trp
Pro Tyr 85 90 95 Thr Phe Gly Gln Gly Thr Lys Leu Glu Ile Lys Arg
100 105 47375DNAArtificial SequenceSynthetic 47gaagtgcagc
tggtggagtc tgggggcggc ttggtacagc ctggcaggtc cctgagactc 60tcctgtgcag
cccctggatt caactttgat gattatgcca tgcactgggt ccggcaaact
120ccagggaagg gcctggagtg ggtctcaggt attagttgga atagtggtac
tataggctat 180gcggactctg tgaagggccg atttaccatc tccagagaca
acgccaagaa ctccctgtat 240cttcaaatga acagtctgag acctgaggac
acggccttgt attactgtgc aaaagaaggg 300gtatggttcg gaaaattgtt
ctcatcctac ggtatggacg tctggggcca agggaccacg 360gtcaccgtct cctca
37548125PRTArtificial SequenceSynthetic 48Glu Val Gln Leu Val Glu
Ser Gly Gly Gly Leu Val Gln Pro Gly Arg1 5 10 15 Ser Leu Arg Leu
Ser Cys Ala Ala Pro Gly Phe Asn Phe Asp Asp Tyr 20 25 30 Ala Met
His Trp Val Arg Gln Thr Pro Gly Lys Gly Leu Glu Trp Val 35 40 45
Ser Gly Ile Ser Trp Asn Ser Gly Thr Ile Gly Tyr Ala Asp Ser Val 50
55 60 Lys Gly Arg Phe Thr Ile Ser Arg Asp Asn Ala Lys Asn Ser Leu
Tyr65 70 75 80 Leu Gln Met Asn Ser Leu Arg Pro Glu Asp Thr Ala Leu
Tyr Tyr Cys 85 90 95 Ala Lys Glu Gly Val Trp Phe Gly Lys Leu Phe
Ser Ser Tyr Gly Met 100 105 110 Asp Val Trp Gly Gln Gly Thr Thr Val
Thr Val Ser Ser 115 120 125 49324DNAArtificial SequenceSynthetic
49gaaatagtga tgacgcagtc tccagccacc ctgtctgtgt ctccagggga aagagccacc
60ctctcctgca gggccagtca gagtgttact tacaacttag actggtacca gcagaaacct
120ggccaggctc ccaggctcct catctttggt gcatccacca gggccactgg
tatcccagcc 180aggttcagtg gcagtgggtc tgggacagag ttcactctca
ccatcaccag cctgcagtct 240gaagattttg cagtttatta ctgtcagcag
tataataact ggccgtacac ttttggccag 300gggaccaagc tggagatcaa acga
32450108PRTArtificial SequenceSynthetic 50Glu Ile Val Met Thr Gln
Ser Pro Ala Thr Leu Ser Val Ser Pro Gly1 5 10 15 Glu Arg Ala Thr
Leu Ser Cys Arg Ala Ser Gln Ser Val Thr Tyr Asn 20 25 30 Leu Asp
Trp Tyr Gln Gln Lys Pro Gly Gln Ala Pro Arg Leu Leu Ile 35 40 45
Phe Gly Ala Ser Thr Arg Ala Thr Gly Ile Pro Ala Arg Phe Ser Gly 50
55 60 Ser Gly Ser Gly Thr Glu Phe Thr Leu Thr Ile Thr Ser Leu Gln
Ser65 70 75 80 Glu Asp Phe Ala Val Tyr Tyr Cys Gln Gln Tyr Asn Asn
Trp Pro Tyr 85 90 95 Thr Phe Gly Gln Gly Thr Lys Leu Glu Ile Lys
Arg 100 105 518PRTArtificial SequenceSynthetic 51Xaa Xaa Xaa Xaa
Xaa Xaa Xaa Xaa 1 5 528PRTArtificial SequenceSynthetic 52Xaa Xaa
Xaa Xaa Xaa Xaa Xaa Xaa 1 5 5318PRTArtificial SequenceSynthetic
53Xaa Xaa Xaa Xaa Xaa Xaa Xaa Xaa Xaa Xaa Xaa Xaa Xaa Xaa Xaa Xaa 1
5 10 15 Xaa Xaa546PRTArtificial SequenceSynthetic 54Xaa Xaa Xaa Xaa
Xaa Xaa 1 5 553PRTArtificial SequenceSynthetic 55Xaa Xaa Xaa 1
569PRTArtificial SequenceSynthetic 56Xaa Xaa Xaa Xaa Xaa Xaa Xaa
Xaa Xaa 1 5 57330PRTArtificial SequenceSynthetic 57Ala Ser Thr Lys
Gly Pro Ser Val Phe Pro Leu Ala Pro Ser Ser Lys 1 5 10 15 Ser Thr
Ser Gly Gly Thr Ala Ala Leu Gly Cys Leu Val Lys Asp Tyr 20 25 30
Phe Pro Glu Pro Val Thr Val Ser Trp Asn Ser Gly Ala Leu Thr Ser 35
40 45 Gly Val His Thr Phe Pro Ala Val Leu Gln Ser Ser Gly Leu Tyr
Ser 50 55 60 Leu Ser Ser Val Val Thr Val Pro Ser Ser Ser Leu Gly
Thr Gln Thr65 70 75 80 Tyr Ile Cys Asn Val Asn His Lys Pro Ser Asn
Thr Lys Val Asp Lys 85 90 95 Lys Val Glu Pro Lys Ser Cys Asp Lys
Thr His Thr Cys Pro Pro Cys 100 105 110 Pro Ala Pro Glu Leu Leu Gly
Gly Pro Ser Val Phe Leu Phe Pro Pro 115 120 125 Lys Pro Lys Asp Thr
Leu Met Ile Ser Arg Thr Pro Glu Val Thr Cys 130 135 140 Val Val Val
Asp Val Ser His Glu Asp Pro Glu Val Lys Phe Asn Trp145 150 155 160
Tyr Val Asp Gly Val Glu Val His Asn Ala Lys Thr Lys Pro Arg Glu 165
170 175 Glu Gln Tyr Asn Ser Thr Tyr Arg Val Val Ser Val Leu Thr Val
Leu 180 185 190 His Gln Asp Trp Leu Asn Gly Lys Glu Tyr Lys Cys Lys
Val Ser Asn 195 200 205 Lys Ala Leu Pro Ala Pro Ile Glu Lys Thr Ile
Ser Lys Ala Lys Gly 210 215 220 Gln Pro Arg Glu Pro Gln Val Tyr Thr
Leu Pro Pro Ser Arg Asp Glu225 230 235 240 Leu Thr Lys Asn Gln Val
Ser Leu Thr Cys Leu Val Lys Gly Phe Tyr 245 250 255 Pro Ser Asp Ile
Ala Val Glu Trp Glu Ser Asn Gly Gln Pro Glu Asn 260 265 270 Asn Tyr
Lys Thr Thr Pro Pro Val Leu Asp Ser Asp Gly Ser Phe Phe 275 280 285
Leu Tyr Ser Lys Leu Thr Val Asp Lys Ser Arg Trp Gln Gln Gly Asn 290
295 300 Val Phe Ser Cys Ser Val Met His Glu Ala Leu His Asn His Tyr
Thr305 310 315 320 Gln Lys Ser Leu Ser Leu Ser Pro Gly Lys 325 330
58327PRTArtificial SequenceSynthetic 58Ala Ser Thr Lys Gly Pro Ser
Val Phe Pro Leu Ala Pro Cys Ser Arg 1 5 10 15 Ser Thr Ser Glu Ser
Thr Ala Ala Leu Gly Cys Leu Val Lys Asp Tyr 20 25 30 Phe Pro Glu
Pro Val Thr Val Ser Trp Asn Ser Gly Ala Leu Thr Ser 35 40 45 Gly
Val His Thr Phe Pro Ala Val Leu Gln Ser Ser Gly Leu Tyr Ser 50 55
60 Leu Ser Ser Val Val Thr Val Pro Ser Ser Ser Leu Gly Thr Lys
Thr65 70 75 80 Tyr Thr Cys Asn Val Asp His Lys Pro Ser Asn Thr Lys
Val Asp Lys 85 90 95 Arg Val Glu Ser Lys Tyr Gly Pro Pro Cys Pro
Ser Cys Pro Ala Pro 100 105 110 Glu Phe Leu Gly Gly Pro Ser Val Phe
Leu Phe Pro Pro Lys Pro Lys 115 120 125 Asp Thr Leu Met Ile Ser Arg
Thr Pro Glu Val Thr Cys Val Val Val 130 135 140 Asp Val Ser Gln Glu
Asp Pro Glu Val Gln Phe Asn Trp Tyr Val Asp145 150 155 160 Gly Val
Glu Val His Asn Ala Lys Thr Lys Pro Arg Glu Glu Gln Phe 165 170 175
Asn Ser Thr Tyr Arg Val Val Ser Val Leu Thr Val Leu His Gln Asp 180
185 190 Trp Leu Asn Gly Lys Glu Tyr Lys Cys Lys Val Ser Asn Lys Gly
Leu 195 200 205 Pro Ser Ser Ile Glu Lys Thr Ile Ser Lys Ala Lys Gly
Gln Pro Arg 210 215 220 Glu Pro Gln Val Tyr Thr Leu Pro Pro Ser Gln
Glu Glu Met Thr Lys225 230 235 240 Asn Gln Val Ser Leu Thr Cys Leu
Val Lys Gly Phe Tyr Pro Ser Asp 245 250 255 Ile Ala Val Glu Trp Glu
Ser Asn Gly Gln Pro Glu Asn Asn Tyr Lys 260 265 270 Thr Thr Pro Pro
Val Leu Asp Ser Asp Gly Ser Phe Phe Leu Tyr Ser 275 280 285 Arg Leu
Thr Val Asp Lys Ser Arg Trp Gln Glu Gly Asn Val Phe Ser 290 295 300
Cys Ser Val Met His Glu Ala Leu His Asn His Tyr Thr Gln Lys Ser305
310 315 320 Leu Ser Leu Ser Leu Gly Lys 325 59327PRTArtificial
SequenceSynthetic 59Ala Ser Thr Lys Gly Pro Ser Val Phe Pro Leu Ala
Pro Cys Ser Arg 1 5 10 15 Ser Thr Ser Glu Ser Thr Ala Ala Leu Gly
Cys Leu Val Lys Asp Tyr 20 25 30 Phe Pro Glu Pro Val Thr Val Ser
Trp Asn Ser Gly Ala Leu Thr Ser 35 40 45 Gly Val His Thr Phe Pro
Ala Val Leu Gln Ser Ser Gly Leu Tyr Ser 50 55 60 Leu Ser Ser Val
Val Thr Val Pro Ser Ser Ser Leu Gly Thr Lys Thr65 70 75 80 Tyr Thr
Cys Asn Val Asp His Lys Pro Ser Asn Thr Lys Val Asp Lys 85 90 95
Arg Val Glu Ser Lys Tyr Gly Pro Pro Cys Pro Pro Cys Pro Ala Pro 100
105 110 Glu Phe Leu Gly Gly Pro Ser Val Phe Leu Phe Pro Pro Lys Pro
Lys 115 120 125 Asp Thr Leu Met Ile Ser Arg Thr Pro Glu Val Thr Cys
Val Val Val 130 135 140 Asp Val Ser Gln Glu Asp Pro Glu Val Gln Phe
Asn Trp Tyr Val Asp145 150 155 160 Gly Val Glu Val His Asn Ala Lys
Thr Lys Pro Arg Glu Glu Gln Phe 165 170 175 Asn Ser Thr Tyr Arg Val
Val Ser Val Leu Thr Val Leu His Gln Asp 180 185 190 Trp Leu Asn Gly
Lys Glu Tyr Lys Cys Lys Val Ser Asn Lys Gly Leu 195 200 205 Pro Ser
Ser Ile Glu Lys Thr Ile Ser Lys Ala Lys Gly Gln Pro Arg 210 215 220
Glu Pro Gln Val Tyr Thr Leu Pro Pro Ser Gln Glu Glu Met Thr Lys225
230 235 240 Asn Gln Val Ser Leu Thr Cys Leu Val Lys Gly Phe Tyr Pro
Ser Asp 245 250 255 Ile Ala Val Glu Trp Glu Ser Asn Gly Gln Pro Glu
Asn Asn Tyr Lys 260 265 270 Thr Thr Pro Pro Val Leu Asp Ser Asp Gly
Ser Phe Phe Leu Tyr Ser 275 280 285 Arg Leu Thr Val Asp Lys Ser Arg
Trp Gln Glu Gly Asn Val Phe Ser 290 295 300 Cys Ser Val Met His Glu
Ala Leu His Asn His Tyr Thr Gln Lys Ser305 310 315 320 Leu Ser Leu
Ser Leu Gly Lys 325
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